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
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

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 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

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 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
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
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
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

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 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
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
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
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
CSV