CDE Detailed Report

Disease: content
Sub-Domain: Quality of Life/Patient Reported Outcomes
CRF: welcome

Displaying 1 - 18 of 18
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C17014 Headache Impact Questionnaire (HImQ) - off chores 3-month headache count HlmQOffChoreDay3MoHdchCt Count the days in the last 3 months you have been kept from doing housework or chores for at least half of the day because of your headaches, as part of Headache Impact Questionnaire. Count the days in the last 3 months you have been kept from doing housework or chores for at least half of the day because of your headaches as part of Headache Impact Questionnaire How many days in the last 3 months have you been kept from doing housework or chores for at least half of the day because of your headaches? Numeric Values

Record number of days.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

0 92
C17004 Headache Impact Questionnaire (HImQ) - headache days 3 months count HImQHdchDay3MoCt Count the days of your headaches during the past 3 months, as part of Headache Impact Questionnaire. Count the days of your headaches during the past 3 months as part of Headache Impact Questionnaire On how many days in the last 3 months have you had a headache? Numeric Values

Please answer the questions about headaches you have had in the last three months. Answer in number of days

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

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C17015 Headache Impact Questionnaire (HImQ) - Chore ability reduced headache percent measure HlmQChoreAbRedHdchPercntMeasr Measurement of percentage of reduced ability to do housework or chores when you have a headache, as part of Headache Impact Questionnaire. Measurement of percentage of reduced ability to do housework or chores when you have a headache as part of Headache Impact Questionnaire When you have a headache, how much is your ability to do housework or chores reduced? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to work Alphanumeric

0% is 'not at all' and 100% is 'unable to work' Mark an "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
C17005 Headache Impact Questionnaire (HImQ) - last headache time count HImQLstHdchTimeCt Count the time of your last headache, as part of Headache Impact Questionnaire. Count the time of your last headache as part of Headache Impact Questionnaire When was your last headache? Numeric Values

Record in days, weeks or months.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

C17016 Headache Impact Questionnaire (HImQ) - off non-work activities 3-month headache count HlmQOffNonWrkActDay3MoHdchCt Count the days in the last 3 months you have been kept from non-work activities (family, social, or recreational) because of your headaches, as part of Headache Impact Questionnaire. Count the days in the last 3 months you have been kept from non-work activities (family, social, or recreational) because of your headaches as part of Headache Impact Questionnaire How many days in the last 3 months have you been kept from non-work activities (family, social, or recreational) because of your headaches? Numeric Values

Record number of days.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

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C17006 Headache Impact Questionnaire (HImQ) - headache duration HlmQHdchDur The duration your headaches usually last, as part of Headache Impact Questionnaire. The duration your headaches usually last as part of Headache Impact Questionnaire How long do your headaches usually last? Numeric Values

Record in hours and/or minutes.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

C17017 Headache Impact Questionnaire (HImQ) - activities ability reduced percentage measurement HlmQActAbltyRedHdchPercntMeasr Measurement of percentage of reduced ability to engage non-work activities (family, social, or recreational) when you have a headache, as part of Headache Impact Questionnaire. Measurement of percentage of reduced ability to engage non-work activities (family, social, or recreational) when you have a headache as part of Headache Impact Questionnaire When you have a headache, how much is your ability to engage in non-work activities (family, social, or recreational) reduced? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to do activities Alphanumeric

0% is 'not at all' and 100% is 'unable to do activities'

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
C17007 Headache Impact Questionnaire (HImQ) - headache scale HlmQHdchScale Scale the pain from your headache on a scale of 0 to 10, as part of Headache Impact Questionnaire. Scale the pain from your headache on a scale of 0 to 10 as part of Headache Impact Questionnaire How would you rate the pain from your headache on a scale of 0 to 10? 0;1;2;3;4;5;6;7;8;9;10 No pain at all;1;2;3;4;5;6;7;8;9;Pain as bad as it can be Numeric values

0 is 'no pain at all' and "10" is 'pain as bad as it can be' Mark and "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17018 Headache Impact Questionnaire (HImQ) - nausea headache frequency HlmQNauseaHdchFreq Frequency of nausea while having a headache as part of Headache Impact Questionnaire, as part of Headache Impact Questionnaire. Frequency of nausea while having a headache as part of Headache Impact Questionnaire as part of Headache Impact Questionnaire With your headaches, how often do you have nausea? Never;Rarely;Less than half the time;Half the time or more often Never;Rarely;Less than half the time;Half the time or more often Alphanumeric

Check the best answer

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17008 Headache Impact Questionnaire (HImQ) - severe headache percent frequency HlmQSevHdchPercntFreq Frequency represented by percentage of time having severe headaches, as part of Headache Impact Questionnaire. Frequency represented by percentage of time having severe headaches as part of Headache Impact Questionnaire When you have headaches, how often is the pain severe? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always Alphanumeric

Mark and "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
C17019 Headache Impact Questionnaire (HImQ) - avoid light sound headache frequency HlmQAvoidLghtSndHdchFreq Frequency of going to a dark or quiet room to avoid light or sound while having headaches, as part of Headache Impact Questionnaire. Frequency of going to a dark or quiet room to avoid light or sound while having headaches as part of Headache Impact Questionnaire With your h headaches, how often do you go to a dark or quiet room to avoid light or sound? Never;Rarely;Less than half the time;Half the time or more often Never;Rarely;Less than half the time;Half the time or more often Alphanumeric

Check the best answer

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17009 Headache Impact Questionnaire (HImQ) - lie down headache percent frequency HlmQLieDwnHdchPercntFreq Frequency represented by percentage of time you lie down to rest when you have a headache, as part of Headache Impact Questionnaire. Frequency represented by percentage of time you lie down to rest when you have a headache as part of Headache Impact Questionnaire When you have a headache, how often do you lie down and rest where 0% is never and 100% is always? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always Alphanumeric

Mark and "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
C17020 Headache Impact Questionnaire (HImQ) - headache changed 3-month type HlmQHdchChnged3MoTyp Type of changed headache during the last 3 months, as part of Headache Impact Questionnaire. Type of changed headache during the last 3 months as part of Headache Impact Questionnaire If your headaches have changed during the last 3 months, how have they changed? 0;1;2;3;4;5;6;7 No change at all;Headaches are more frequent;Headaches are less frequent;Headaches last longer;Headaches are shorter;Headaches are more severe;Headaches are less severe;Other, specify Alphanumeric

Choose all that apply.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17010 Headache Impact Questionnaire (HImQ) - lie down days 3-month headache count HlmQLieDwnDay3MoHdchCt Count the days you lied down for an hour or more in the last 3 months because of your headaches, as part of Headache Impact Questionnaire. Count the days you lied down for an hour or more in the last 3 months because of your headaches as part of Headache Impact Questionnaire How many days in the last 3 months did you actually lie down for an hour or more because of your headaches? Numeric Values

Please answer the questions about headaches you have had in the last three months.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

0 92
C17021 Headache Impact Questionnaire (HImQ) - headache changed 3-month other text HlmQHdchChnged3MoOthrTxt Specify the text of change if you answered "Other (Specify)" to the last question, as part of Headache Impact Questionnaire. Specify the text of change if you answered "Other (Specify)" to the last question as part of Headache Impact Questionnaire Other Specify Alphanumeric

Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q20

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points 255

Free-Form Entry

C17011 Headache Impact Questionnaire (HImQ) - miss school work headache percent frequency HlmQMisSchWrkHdchPercntFreq Frequency represented by percentage of time you missed work or school for all or part of the day when you have a headache, as part of Headache Impact Questionnaire. Frequency represented by percentage of time you missed work or school for all or part of the day when you have a headache as part of Headache Impact Questionnaire When you have a headache, how often do you miss work or school for all or part of the day where 0% is never and 100% is always? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Never;10%;20%;30%;40%;Half the time;60%;70%;80%;90%;Always Alphanumeric

Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11. '0' is 'Never', '50%' is 'Half the time' and '100%' is always Mark an "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
C17012 Headache Impact Questionnaire (HImQ) - off school work 3-month headache count HlmQOffSchWrkDay3MoHdchCt Count the days you have been kept from work activities (work or school) for at least half of the day in the last 3 months because of your headaches, as part of Headache Impact Questionnaire. Count the days you have been kept from work activities (work or school) for at least half of the day in the last 3 months because of your headaches as part of Headache Impact Questionnaire How many days in the last 3 months have you been kept from work activities (work or school) for at least half of the day because of your headaches? Numeric Values

Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

0 92
C17013 Headache Impact Questionnaire (HImQ) - work ability reduced percentage measurement HlmQWrkAbltyRedHdchPercntMeasr Measurement of percentage of reduced ability to work when you have a headache, as part of Headache Impact Questionnaire. Measurement of percentage of reduced ability to work when you have a headache as part of Headache Impact Questionnaire When you have a headache while you work (work or school), how much is your ability to work reduced? 0%;10%;20%;30%;40%;50%;60%;70%;80%;90%;100% Not reduced at all;10%;20%;30%;40%;Reduced by half;60%;70%;80%;90%;Unable to work Alphanumeric

Answer Q8, Q9, and Q10 if you are currently employed outside the home or if you go to school. If not, skip to Q11. Mark an "X" on the line.

Copyright:Dr. Richard Lipton Stewart, WF, Lipton RB, Simon, D, Korff MV, Liberman, J. 1998. Reliability of Illness Severity Measure for Headache in a Population sample of Migrain Sufferers. Adult Exploratory 3.00 2013-07-16 14:01:43.01 Headache Impact Questionnaire (HImQ) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

percent
CSV