CDE Detailed Report

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

Displaying 51 - 63 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
C59637 Headache additional symptom type HdchAddtnlSymptmTyp Type of additional symptoms the participant/subject experienced with headache Type of additional symptoms the participant/subject experienced with headache Headache Symptom Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating Alphanumeric

Choose all that apply

 Adult;Pediatric Supplemental 1.00 2023-08-14 21:13:24.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected
C16208 Family history medical condition second-degree relative type FamHistMedclCondScndDegReltTyp Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of second-degree relative(s) to participant/subject 11;12;13;14;15;16;17;18;19;20;21;22;23;24 Half-Sibling Male;Half-Sibling Female;Maternal Grandmother;Maternal Grandfather;Paternal Grandmother;Paternal Grandfather;Maternal Aunt;Maternal Uncle;Paternal Aunt;Paternal Uncle;Grandchild Male;Grandchild Female;Nephew;Niece Numeric Values

Separate multiple codes with comma

 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
C59616 Headache day since onset count HdchDaySinceOnsetCt Count of days passed since participant's/subject's onset of post traumatic headache Count of days passed since participant's/subject's onset of post traumatic headache Number of days passed since onset of PTH: 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 (b) For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio, (a/b) x100, where a = number of days with a headache of any duration (minutes or hours) of any kind of severity (mild, moderate or severe), and b = Number of days passed since onset of post traumatic headache

 Adult;Pediatric Supplemental 1.10 2023-08-14 18:49:21.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C59648 Neck pain stiffness without headache frequency category NeckPnStffnessWthoutHdchFrqCat Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject Neck Pain/Stiffness 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 21:34:31.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C59627 Month code MonthCode Ordinal month code identifying the month within a specified count of months Ordinal month code identifying the month within a specified count of months For patients with greater than one month to 6 months of PTH Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 20:56:16.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C19035 Headache aura symptom other text HdchAurasSymOTH The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start Other, specify Alphanumeric Adult;Pediatric Supplemental 3.10 2023-08-14 20:18:00.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events 4000

Free-Form Entry
C59638 Headache additional symptom type present indicator HdchAddtnlSympTypPresentInd Indicator of whether the participant's/subject's headache symptom is present Indicator of whether the participant's/subject's headache symptom is present Is Symptom Present? Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2023-08-14 21:15:53.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C59617 Headache less than 30 day ratio value HdchLessThan30DayRatVal Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days Headache Ratio calculation (a/b) x100 Numeric Values

For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio as follows:
If patient describes having 10 headache days since onset of post traumatic headache and is being tested on day 20 post onset of post traumatic headache then (10/20) x 100 = 50%

 Adult;Pediatric Supplemental 1.00 2023-08-14 20:27:07.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry
C59649 Dizziness vertigo without headache frequency category DizznessVertgoWthoutHdchFrqCat Category that describes how frequently the headache associated symptom of dizziness and/or vertigo affects the participant/subject Category that describes how frequently the headache associated symptom of dizziness and/or vertigo affects the participant/subject Dizziness and/or vertigo Never;Almost Never;Sometimes;Often;Almost always Never;Almost Never;Sometimes;Often;Almost always Alphanumeric

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 Adult;Pediatric Supplemental 1.10 2023-10-12 10:13:55.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C59628 Headache days per month count HdchDaysPerMnthCt Count of the number of days the participant/subject experienced headaches in a month Count of the number of days the participant/subject experienced headaches in a month Headache days per month 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

For patients with greater than one month to 6 months of post traumatic headache indicate number of headache days per month (30 days)

 Adult;Pediatric Supplemental 1.00 2023-08-14 20:59:05.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
C05400 Injury date time InjDateTime Date (and time, if applicable and known) of injury Date (and time, if applicable and known) of injury Date of TBI that led to current PTH Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry
C59607 Headache traumatic brain injury previous count HdchTBIPreviousCt Count of previous traumatic brain injuries not including the current event experienced by the participant/subject that led to the current post traumatic headache Count of previous traumatic brain injuries not including the current event experienced by the participant/subject that led to the current post traumatic headache Number of previous TBIs (concussions) (not including the TBI (concussion) that led to current post-traumatic headache) Numeric Values

Example: 0= no prior TBIs; 1= one prior TBI

 Adult;Pediatric Supplemental 1.10 2023-08-14 18:44:36.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry
C59639 Headache additional symptom laterality type HdchAddtnlSympLateralTyp Laterality type of the participant's/subject's headache symptom Laterality type of the participant's/subject's headache symptom If 'Yes', is Symptom Unilateral or Bilateral? Unilateral;Bilateral Unilateral;Bilateral Alphanumeric

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 Adult;Pediatric Supplemental 1.00 2023-08-14 21:17:24.0 Post-traumatic Headache (PTH) Mild TBI Questionnaire History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected
CSV