CDE Detailed Report

Disease: Headache
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) Mild TBI Questionnaire

Displaying 1 - 50 of 63
CDE ID CDE Name Variable Name Definition Short Description Question Text Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C59650 Gait postural imbalance without headache frequency category GaitPstrImblncWthoutHdchFrqCat Category that describes how frequently the headache associated symptom of gait and/or postural imbalance affects the participant/subject Category that describes how frequently the headache associated symptom of gait and/or postural imbalance affects the participant/subject Gait and/or postural imbalance Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:38:06.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59618 Headache mild average monthly frequency HdchMildAvgMnthFreq Frequency of the average monthly headaches the participant/subject experienced with mild severity Frequency of the average monthly headaches the participant/subject experienced with mild severity Average monthly headache frequency of any kind with mild severity 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 Numeric Values

Indicate average number of days patient had any kind of headache of mild severity. For patients who have had post traumatic headache for at least 30 days

Adult;Pediatric Supplemental 1.00 2023-08-14 20:36:44.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15897 Headache associated symptom type HdchAssocSymptmTyp The associated symptoms the participant/subject experienced with headache Type of symptoms associated with the headache Symptom Nausea;Vomiting;Sensitive to light;Sensitive to noise;Neck Pain/Stiffness;Dizziness and/or vertigo;Gait and/or postural imbalance;Difficulty with memory/concentration Nausea;Vomiting;Sensitive to light;Sensitive to noise;Neck Pain/Stiffness;Dizziness and/or vertigo;Gait and/or postural imbalance;Difficulty with memory/concentration Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59629 Headache inadequate treatment duration HdchInadequateTxDur Duration of participant's/subject's inadequately treated headache Duration of participant's/subject's inadequately treated headache How long did headaches last if untreated/inadequately treated? Numeric Values

Duration is recorded in hours and minutes (HH:MM)

Adult;Pediatric Supplemental 1.00 2023-08-14 21:00:36.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C59640 Headache additional symptom unilateral same side present indicator HdchAddtnlSympUnilatSmSdPrsInd Indicator of whether the participant's/subject's symptom is present on the same side to the headache Indicator of whether the participant's/subject's symptom is present on the same side to the headache If 'Unilateral', is Symptom Present on Same Side to Headache? Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:18:48.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59608 Headache post traumatic prior history indicator HdchPostTraumaPriorHxInd Indicator of whether the participant/subject experienced previous post traumatic headaches Indicator of whether the participant/subject experienced previous post traumatic headaches If patient had a history of prior TBIs, did patient suffer PTH in the past Yes;No Yes;No Alphanumeric

Check one

Adult;Pediatric Supplemental 1.10 2023-08-14 18:45:01.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59651 Memory concentration difficult without symptom frequency category MemCncntDffcltWthoutHdchFrqCat Category that describes how frequently the headache associated symptom memory/concentration effects the participant/subject Category that describes how frequently the headache associated symptom memory/concentration effects the participant/subject Difficulty with memory/concentration Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:41:10.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59619 Headache moderate average monthly frequency HdchModerateAvgMnthFreq Frequency of the average monthly headaches the participant/subject experienced with moderate severity Frequency of the average monthly headaches the participant/subject experienced with moderate severity Average monthly headache frequency of any kind with moderate severity 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 Numeric Values

Indicate average number of days patient had any kind of headache of moderate severity. For patients who have had post traumatic headache for at least 30 days

Adult;Pediatric Supplemental 1.00 2023-08-14 20:41:25.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15917 Headache typical pain intensity rate scale HeadacheTypPainIntstyRateScl Rating scale for the pain of this headache on a scale of 0 -10 Rating scale for the pain of this headache on a scale of 0 -10 Typical headache pain intensity: 0 (no pain) to 10 (most severe pain) scale 0;1;2;3;4;5;6;7;8;9;10 0;1;2;3;4;5;6;7;8;9;10 Numeric Values

Choose one

Adult;Pediatric Supplemental 4.10 2023-06-02 10:23:14.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59630 Headache laterality anatomic site HdchLateralAnatSite Anatomic site location of the headache Anatomic site location of the headache Where were the headaches usually located? Right;Left;Front;Back;Top;Side/Temples Right;Left;Front;Back;Top;Side/Temples Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 1.00 2023-08-14 21:04:11.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59641 Headache aura occurrence indicator HdchAuraOccurInd Indicator of whether the participant/subject has an aura occur with headache Indicator of whether the participant/subject has an aura occur with headache Auras with headaches Yes;No Yes;No Alphanumeric

Please refer to the ICHD3 document for descriptions of the aura type

Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211. Adult;Pediatric Supplemental 1.00 2023-08-14 21:22:36.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59609 Headache post traumatic prior history time unit count HdchPostTraumaPrrHxTmUnitCt Number of days, months or years the participant/subject suffered from post traumatic headache Number of days, months or years the participant/subject suffered from post traumatic headache If 'Yes', how long ago did you suffer from PTH? Numeric Values

Indicate number of days, months or years

Adult;Pediatric Supplemental 1.10 2023-08-14 18:45:35.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C59652 Aura without headache frequency category AuraWthoutHdchFreqCat Category that describes how frequently the headache associated symptom of aura without headache affects the participant/subject Category that describes how frequently the headache associated symptom of aura without headache affects the participant/subject Aura without headache Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:43:12.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59620 Headache severe average monthly frequency HdchSevereAvgMnthFreq Frequency of the average monthly headaches the participant/subject experienced with severe severity Frequency of the average monthly headaches the participant/subject experienced with severe severity Average monthly headache frequency of any kind with severe severity 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 Numeric Values

Indicate average number of days patient had any kind of headache of severe severity. For patients who have had post traumatic headache for at least 30 days

Adult;Pediatric Supplemental 1.00 2023-08-14 20:42:23.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15936 Headache history indicator HeadachHistInd Indicates whether participant/subject suffers from headaches Indicates whether participant/subject suffers from headaches Did patient have pre-existing headaches? Yes;No Yes;No Alphanumeric

For patients with pre-existing headache

Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59631 Headache laterality type HdchLateralTyp Type of side were headache is located Type of side were headache is located What side(s) are the headache(s) usually on Right only;Left only;Both sides;Alternating sides Right only;Left only;Both sides;Alternating sides Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 1.00 2023-08-14 21:06:04.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59642 Headache aura symptom type frequency category HdchAuraSympTypFreqCat Category that describes how the aura symptom type effects the participant/subject Category that describes how the aura symptom type effects the participant/subject Did the individual experience the following aura types with headaches Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:24:09.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59610 Headache post traumatic prior history unit of measure HdchPostTraumaPrrHxUOM Unit of measure for the number of days, months or years the participant/subject suffered from post traumatic headache Unit of measure for the number of days, months or years the participant/subject suffered from post traumatic headache If 'Yes', how long ago did you suffer from PTH? Days;Months;years Days;Months;years Alphanumeric

Check appropriate unit of measure

Adult;Pediatric Supplemental 1.10 2023-08-14 18:46:05.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59653 Headache post traumatic phenotype type HdchPostTraumaPhenotypeTyp Type describing phenotype of post traumatic headache Type describing phenotype of post traumatic headache Post-traumatic headache phenotype Migraine with aura;Migraine without aura;Chronic Migraine;Other, specify;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache Migraine with aura;Migraine without aura;Chronic Migraine;Other, specify;Episodic cluster headache;Chronic cluster headache;Cervicogenic headache;Infrequent episodic tension-type headache;Frequent episodic tension-type headache;Chronic tension-type headache Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 1.00 2023-08-14 21:44:11.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59621 Headache post traumatic complete freedom monthly frequency day count HdchPstTrmCmplFreeMoFrqDyCt Count of monthly frequency of headaches the participant/subject experienced completely free from headache Count of monthly frequency of headaches the participant/subject experienced completely free from headache Average days per month of complete headache freedom 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 Numeric Values

Indicate average number of days patient was completely free from headaches. For patients who have had post traumatic headache for at least 30 days

Adult;Pediatric Supplemental 1.00 2023-08-14 20:43:03.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15937 Headache typical severity type HeadachTypclSevertyTyp Level of headache intensity described by the participant/subject Level of headache intensity described by the participant/subject Intensity Mild;Moderate;Severe Mild;Moderate;Severe Alphanumeric

Choose one

Adult;Pediatric Supplemental 3.10 2023-08-14 08:41:42.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59632 Headache maximum pain intensity scale HdchMaxPainIntstyScl Rating scale of the maximum headache pain intensity described by the participant/subject Rating scale of the maximum headache pain intensity described by the participant/subject Maximum headache pain intensity: 0 (no pain) to 10 (most severe pain) scale 0;1;2;3;4;5;6;7;8;9;10 0;1;2;3;4;5;6;7;8;9;10 Numeric Values Adult;Pediatric Supplemental 1.00 2023-08-14 21:07:20.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59643 Headache aura experience percent value HdchAuraExprncPctVal Value of (the percentage of) headaches the participant/subject experience with auras Value of (the percentage of) headaches the participant/subject experience with auras Percentage of headaches experienced with auras Numeric Values

Percentage value may be an estimation

Adult;Pediatric Supplemental 1.00 2023-08-14 21:25:45.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 100 percent
C59611 Headache post traumatic start date HdchPostTraumaStartDate Date (and time, if applicable and known) for the start of participant's/subject's post traumatic headache Date (and time, if applicable and known) for the start of participant's/subject's post traumatic headache Date that PTH started Date or Date & Time

When date/time data are prepared for aggregation or sharing they should be converted to the format specified by ISO 8601, YYYY-MM-DD; hh:mm:ss.

ISO 8601 - https://www.iso.org/iso-8601-date-and-time-format.html Adult;Pediatric Supplemental 1.10 2023-08-14 18:46:29.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C59654 Headache post traumatic phenotype type other text HdchPostTraumaPhenotypOTH The free-text field related to 'Headache post traumatic phenotype type' specifying other text The free-text field related to 'Headache post traumatic phenotype type' specifying other text Other, Specify Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:49:05.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C59622 Headache at least 30 days ratio value HdchAtLeast30DayRatioVal Value which represents the headache ratio calculation. Applies only to patients that have had post traumatic headache for at least 30 days Value which represents the headache ratio calculation. Applies only to patients that have had post traumatic headache for at least 30 days Headache Ratio calculation (average number of days with mild, moderate, severe headache/ 30 days) x 100 =___ % of days with headache. Numeric Values

Example: If patient describes an average of 10 headaches of any severity, ratio calculation is as follows: (10/30) x 100 = 33.3%

Adult;Pediatric Supplemental 1.00 2023-08-14 20:45:46.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C15950 Headache typical pain type HdchTypcPainTyp Type of pain the participant/subject experiences with the headache Type of pain the participant/subject experiences with the headache Quality Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing Stabbing;Burning;Pressure/Aching;Pulsating/Throbbing Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59633 Headache current pain scale HdchCurrentPainScl Scale for the current pain of this headache on a scale of 0-10 Scale for the current pain of this headache on a scale of 0-10 Current headache pain level 0 (no pain) to 10 (most severe pain) scale 0;1;2;3;4;5;6;7;8;9;10 0;1;2;3;4;5;6;7;8;9;10 Numeric Values

Choose one

Adult;Pediatric Supplemental 2.00 2023-08-15 12:20:20.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59644 Nausea without headache frequency category NausWthoutHdchFreqCat Category that describes how frequently the headache associated symptom of nausea effects the participant/subject Category that describes how frequently the headache associated symptom of nausea effects the participant/subject Nausea Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:27:44.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59612 Headache traumatic brain injury onset delay duration category HdchTBIOnsetDelayDurCat Category which represents how long after the participant's/subject's traumatic brain injury that their headaches began Category which represents how long after the participant's/subject's traumatic brain injury that their headaches began How long after TBI did headaches begin Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.10 2023-08-14 18:47:00.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59655 Headache category HeadacheCat Type of headache experienced by the participant/subject Type of headache experienced by the participant/subject Headache Type Migraine;Post Traumatic Headache;Other Headache Migraine;Post Traumatic Headache;Other Headache Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 1.00 2023-08-14 21:50:50.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59623 Headache after traumatic brain injury frequency change category HdchAftrTBIFreqChngCat Category which represents headache frequency since participant/subject experienced a traumatic brain injury Category which represents headache frequency since participant/subject experienced a traumatic brain injury Headache frequency since TBI: stable;decreasing in frequency;increasing in frequency stable;decreasing in frequency;increasing in frequency Alphanumeric

Choose one

Adult;Pediatric Supplemental 2.00 2023-08-14 20:48:45.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15961 Headache worse during activity indicator HeadachWorsDurngActvtyInd Indicates whether activity or playing makes headache worse Indicates whether activity or playing makes headache worse Headaches worse with physical activity Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59634 Headache worse with neck movement indicator HdchWorseWthNeckMvmtInd Indicator of whether the subject's/participant's headaches worsen with neck movements Indicator of whether the subject's/participant's headaches worsen with neck movements Headaches worse with neck movements Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:10:43.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59645 Vomiting without headache frequency category VomitWthoutHdchFreqCat Category that describes how frequently the headache associated symptom of vomiting affects the participant/subject Category that describes how frequently the headache associated symptom of vomiting affects the participant/subject Vomiting Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:29:22.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59613 Headache after traumatic brain injury worsen delay duration category HdchAftTBIWorsenDelayDurCat Category which represents when the participant's/subject's headaches began to worsen after a traumatic brain injury Category which represents when the participant's/subject's headaches began to worsen after a traumatic brain injury If yes, how long after TBI did headaches begin to worsen Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days Immediately;Not immediately, but within 24 hours of the TBI;Between 24-72 hours;72 hours to 7 days;After 7 days Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.10 2023-08-14 18:47:36.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59656 Headache category other text HeadacheCatOTH The free-text field related to 'Headache category' specifying other text The free-text field related to 'Headache category' specifying other text Other Headache Type Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:52:09.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C59624 Headache after traumatic brain injury intensity change category HdchAftrTBIIntensChngCat Category which represents headache intensity since participant/subject experienced a traumatic brain injury Category which represents headache intensity since participant/subject experienced a traumatic brain injury Headache intensity since TBI: stable;decreasing in frequency;increasing in frequency stable;decreasing in frequency;increasing in frequency Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 20:49:23.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C15972 Headache aura symptom type HdchAurasSymTyp Type of aura (warning) that a headache was going to start Type of aura (warning) that a headache was going to start Does the individual experience the following aura types with headaches: Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify Visual;Sensory;Speech and/or Language;Motor;Brainstem;Retinal;Other, specify Alphanumeric

Choose all that apply

Adult;Pediatric Supplemental 3.10 2023-08-14 20:18:35.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59635 Headache worse with mental activity indicator HdchWorseWthMentalActvInd Indicator of whether the subject's/participant's headaches worsen with mental activity Indicator of whether the subject's/participant's headaches worsen with mental activity Headaches worse with mental activity (e.g., reading, concentration) Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:11:41.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59646 Sensitivity to light without headache frequency category LightSensitivWthoutHdchFreqCat Category that describes how frequently the headache associated symptom of sensitivity to light effects the participant/subject Category that describes how frequently the headache associated symptom of sensitivity to light effects the participant/subject Sensitivity to light Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:30:20.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59614 Headache continuous indicator HdchContinuousInd Indicator of whether the participant's/subject's headaches have been continuous Indicator of whether the participant's/subject's headaches have been continuous Have headaches been continuous (i.e., 24/7) since onset? Yes;No Yes;No Alphanumeric

Choose one

If 'yes' is checked, then the headache ratio is automatically 100%. Please skip the headache ratio calculation and move to the section "For all patients with PTH to complete".

Adult;Pediatric Supplemental 1.10 2023-08-14 18:48:28.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59657 Headache type family history indicator HeadacheTypFamHxInd Indicator as to whether the participant/subject has a family history of diagnosed headache type Indicator as to whether the participant/subject has a family history of diagnosed headache type Family History of Headache Type? Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:53:18.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59625 Week month code WeekMonthCode Ordinal week code for the weeks in a single month Ordinal week code for the weeks in a single month For patients with less than one month of PTH Week 1;Week 2;Week 3;Week 4 Week 1;Week 2;Week 3;Week 4 Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 20:51:06.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C16207 Family history medical condition first-degree relative type FamHistMedclCondFrstDegReltTyp Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of the first-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of first-degree relative(s) to participant/subject 1;2;3;4;5;6;7;8;9;10 Biological Mother;Biological Father;Sibling Male;Sibling Female;Non-identical or dizygotic twin Male;Non-identical or dizygotic twin Female;Identical twin Male;Identical twin Female;Full biologic child Male;Full biologic child Female Numeric Values

Select the relationship from the options of the family members provided in the "Name of Family Member with Condition" code list. Record more than 1 family member, if applicable. Choose all that apply.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C59636 Headache associated symptom type frequency category HdchAssocSymptmTypFreqCat Category that describes how frequently the headache associated symptom type effects the participant/subject Category that describes how frequently the headache associated symptom type effects the participant/subject Did the individual experience the following symptoms during headache Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:12:27.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59647 Sensitivity to sound without headache frequency category SoundSensitivWthoutHdchFreqCat Category that describes how frequently the headache associated symptom of sensitivity to sound effects the participant/subject Category that describes how frequently the headache associated symptom of sensitivity to sound effects the participant/subject Sensitivity to sound Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

Choose one

Adult;Pediatric Supplemental 1.00 2023-08-14 21:32:13.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59615 Headache day per month frequency HdchDayPerMonthFreq Frequency of headaches the participant/subject experienced within the last 30 days Frequency of headaches the participant/subject experienced within the last 30 days How many days do you have a headache of any duration (minutes or hours) of any kind of severity (mild, moderate or severe)? 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 Numeric Values

Indicate number of days (a) For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio as follows

Example: If patient describes having 10 headache days since onset of PTH and is being tested on day 20 post onset of PTH then (10/20) x 100 = 50%

Adult;Pediatric Supplemental 1.10 2023-08-14 18:48:57.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59658 Relative biological first degree diagnosis headache history indicator RelatvBioFrstDegrDxHxHdchInd Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache Indicator of whether first-degree biological relatives of the participant/subject has a history of diagnosed headache First Degree Biological Relative? Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:54:17.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C59626 Headache days per week count HdchDaysPerWeekCt Count of days the participant/subject experienced headaches in a week Count of days the participant/subject experienced headaches in a week Headache days per week 0;1;2;3;4;5;6;7 0;1;2;3;4;5;6;7 Numeric Values

For patients with less than one month of post traumatic headache indicate the number of days per week patient experienced a headache

Adult;Pediatric Supplemental 1.00 2023-08-14 20:54:36.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

CSV