CDE Detailed Report

Disease: Chiari I Malformation
Sub-Domain: History of Disease/Injury Event
CRF: CMI - Headache Score

Displaying 1 - 22 of 22
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
C21788 Headache quality score HeaQuaScore The score related to the quality of the patient's headache. The score related to the quality of the patient's headache. Score Numeric Values

"Pressure (P)=3 Pounding (P1)=3 Dull ache (D)=2 Sharp (S)=1 Burning (B)=1 Electric-like (E)=0"

Adult;Pediatric Supplemental 1.00 2016-06-02 15:02:06.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 10
C21842 Headache aggravating pain factor type HeaAggPaiRelFacTyp The type as related to factor aggravating headache pain. The type as related to factor aggravating headache pain. Factors increasing headache pain Coughing;Exercise;Neck: Rotation;Sneezing;Lifting;Straining at stool;Laughing;Singing;Crying;Orgasm;Neck: Flexion;Neck: Extension Coughing;Exercise;Neck: Rotation;Sneezing;Lifting;Straining at stool;Laughing;Singing;Crying;Orgasm;Neck: Flexion;Neck: Extension Alphanumeric

"Coughing=3 Sneezing=3 Lifting=3 Straining at stool=3 Exercise=3 Laughing=3 Singing=2 Crying=1 Orgasm=1 Neck: Flexion=1 Neck: Extension=1 Neck: Rotation=1" Identify any that apply

Adult;Pediatric Exploratory 1.00 2016-06-06 08:32:49.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C21790 Headache frequency type HeaFreqTyp The rate at which a headache occurs over a period of time. The rate at which a headache occurs over a period of time. Rate at which headache occurs over a period of time Continuous/prolonged;Daily;Weekly;Monthly;Yearly Continuous/prolonged;Daily;Weekly;Monthly;Yearly Alphanumeric

"identify single descriptive Max score: 5"

Adult;Pediatric Exploratory 1.00 2016-06-02 15:04:05.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21843 Headache aggravating pain factor score HeaAggPaiFacScore The score related to factor aggravating headache pain. The score related to factor aggravating headache pain. Score Numeric Values Adult;Pediatric Exploratory 1.00 2016-06-06 08:38:27.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 25
C21791 Headache frequency score HeaFreqScore The score relating to the rate at which the patient's headache occurs over a period of time. The score relating to the rate at which the patient's headache occurs over a period of time. Score Numeric Values

"identify single descriptive Max score: 5"

Adult;Pediatric Exploratory 1.00 2016-06-02 15:07:05.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

1 5
C21844 Headache assessment total score HeaAssTotScore The total score of headache assessment. The total score of headache assessment. Total Score Numeric Values Adult;Pediatric Exploratory 1.00 2016-06-06 08:39:26.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 120
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 injury Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C21833 Headache symptom association type HeaSymptmAssTyp The type as related to symptoms consistently associated with headache The type as related to symptoms consistently associated with headache Symptoms consistently associated with headache Nausea;Vomiting;Phonophobia;Photophobia;Scotoma;Scintillations Nausea;Vomiting;Phonophobia;Photophobia;Scotoma;Scintillations Alphanumeric

"Nausea=3 Vomiting=2 Scotoma=2 Scintillations=1 Photophobia=1 Phonophobia=1 Identify any that apply Max score: 10"

Adult;Pediatric Supplemental 1.00 2016-06-06 08:01:29.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C15917 Headache typical pain intensity scale HeadacheTypPainIntstyRateScale 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 Intensity on a 1 to 10 scale without medication 1;2;3;4;5;6;7;8;9;10 1;2;3;4;5;6;7;8;9;10 Numeric Values

1 to 10 integer units only

Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21834 Headache symptom association score HeaSymptmAssScore The score related to symptoms consistently associated with headache. The score related to symptoms consistently associated with headache. Score Numeric Values Adult;Pediatric Supplemental 1.00 2016-06-06 08:10:36.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 10
C21778 Headache primary anatomic site HeaPriAntmicSite The location related to the anatomic site of the primary headache The location related to the anatomic site of the primary headache Primary headache site Suboccipital;Retro-orbital;Frontal;Temporal;Vertex;Whole head;N/A Suboccipital;Retro-orbital;Frontal;Temporal;Vertex;Whole head;N/A Alphanumeric

"Max score (Primary area) S: 3+2 = 5 R: 3+2=5 F: 1+2=3 T: 1+2=3 V: 2+2=4 W: 3+2=5 Total - 5 Max; 0 Min"

Adult;Pediatric Exploratory 1.00 2016-06-02 14:38:03.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21835 Headache temporal association type HeaTemAssTyp The type as related to time of occurrence of consistent headache. The type as related to time of occurrence of consistent headache. Consistent headache occurrence in time Daily;Menstrual;With activity/stress;Present on awakening;Nocturnal;After awakening;End of day;With quiet/rest Daily;Menstrual;With activity/stress;Present on awakening;Nocturnal;After awakening;End of day;With quiet/rest Alphanumeric

Scoring criteria: Identify any that apply. Daily=3 With activity/stress=3 Nocturnal=3 Present on awakening=2 Menstrual=1 After awaking=1End of day=1 With quiet/rest=1 Max score: 15.

Adult;Pediatric Supplemental 1.00 2016-06-06 08:13:02.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C21780 Headache primary laterality anatomic site HeaPriLatAntmicSite The location related to the lateral site of the primary headache The location related to the lateral site of the primary headache Primary headache site Left;Right;Both;N/A Left;Right;Both;N/A Alphanumeric

"Max score (Primary area) S: 3+2 = 5 R: 3+2=5 F: 1+2=3 T: 1+2=3 V: 2+2=4 W: 3+2=5 Total - 5 Max; 0 Min"

Adult;Pediatric Exploratory 1.00 2016-06-02 14:48:46.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21836 Headache temporal association score HeaTemAssScore The score related to time of occurrence of consistent headache. The score related to time of occurrence of consistent headache. Score Numeric Values

Max Score: 15

Adult;Pediatric Supplemental 1.00 2016-06-06 08:18:44.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 15
C21782 Headache primary laterality anatomic site score HeaPriLatAntmicSitScore The score relating to the anatomic site of the primary headache. The score relating to the anatomic site of the primary headache. Score Numeric Values Adult;Pediatric Exploratory 1.00 2016-06-02 14:51:33.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 5
C21837 Headache duration type HeaDurTyp The type as related to duration of headache. The type as related to duration of headache. Length of time headache is present Hours;Days;Weeks;Continuous/prolonged;Fleeting Hours;Days;Weeks;Continuous/prolonged;Fleeting Alphanumeric

"identify single descriptive Max score: 5"

Adult;Pediatric Exploratory 1.00 2016-06-06 08:20:12.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21783 Headache focal point extension radiation type HeaFocPoiExtRadTyp The type of extension from the focal point of the headache The type of extension from the focal point of the headache Extension from a focal point Cervical;Retro-orbital;Frontal;Temporal;Vertex Cervical;Retro-orbital;Frontal;Temporal;Vertex Alphanumeric

"Cervical(3) =3 Retro-orbital(R) = 3 Frontal (F) = 1 Temporal (T) = 1 Vertex(V) = 2 Max score: C: 3+2 = 5 R: 3+2=5 F: 1+2=3 T: 1+2=3 V: 2+2=4 W: 3+2=5 Total - 25 Max; 0 Min"

Adult;Pediatric Supplemental 1.00 2016-06-02 14:53:46.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C21838 Headache duration score HeaDurScore The score related to type of duration of headache. The score related to type of duration of headache. Score Numeric Values

Max score: 5

Adult;Pediatric Exploratory 1.00 2016-06-06 08:22:55.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

1 5
C21785 Headache focal point extension radiation score HeaFocPoiExtRadScore The score relating to the extension from the focal point of a headache. The score relating to the extension from the focal point of a headache. Score Numeric Values

"Max score: C: 3+2 = 5 R: 3+2=5 F: 1+2=3 T: 1+2=3 V: 2+2=4 W: 3+2=5 Total - 25 Max; 0 Min"

Adult;Pediatric Supplemental 1.00 2016-06-02 14:57:08.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 25
C21839 Headache pain relief factor type HeaPaiRelFacTyp The type as related to pain relief factor for headache. The type as related to pain relief factor for headache. Factor relieving headache pain Lying down;Sleeping;Medication (anti-inflam);Sitting or standing up;Wearing neck collar Lying down;Sleeping;Medication (anti-inflam);Sitting or standing up;Wearing neck collar Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 08:24:05.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C21786 Headache combination quality type HeaCombQuaTyp The quality of the patient's headache. The quality of the patient's headache. Essential nature, attribute or characteristic Pressure;Pounding;Dull ache;Sharp;Burning;Electric-like Pressure;Pounding;Dull ache;Sharp;Burning;Electric-like Alphanumeric

"Pressure (P)=3 Pounding (P1)=3 Dull ache (D)=2 Sharp (S)=1 Burning (B)=1 Electric-like (E)=0 Max score (All qualities):10"

Adult;Pediatric Supplemental 1.00 2016-06-02 14:58:55.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C21841 Headache pain relief factor score HeaPaiRelFacScore The score related to pain relief factor for headache. The score related to pain relief factor for headache. Score Numeric Values Adult;Pediatric Supplemental 1.00 2016-06-06 08:31:23.0 CMI - Headache Score History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 10
CSV