CDE Detailed Report
Subdomain Name: General Health History
CRF: welcome
Displaying 1 - 23 of 23
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 |
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C17029 | Migraine Disability Assessment (MIDAS) - Headache average pain intensity scale | MIDASHdcheAvePainIntenScl | Average pain scale of the headache experienced by the participant/subject, as part of the Migraine Disability Assessment (MIDAS) Test form. | Average pain scale of the headache experienced by the participant/subject, as part of the Migraine Disability Assessment (MIDAS) Test form. | On a scale of 0-10, on average how painful were these headaches? | Numeric Values |
(Where 0 = no pain at all and 10 = pain as bad as it can be). |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 10 | ||||||||
C54383 | Headache episode duration | HdacheEpisdDur | The element related to the duration of a headache episode | The element related to the duration of a headache episode | How long does each headache episode last? | Greater than 2 hours;Less than 2 hours | Greater than 2 hours;Less than 2 hours | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 08:20:12.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17402 | Site name | SiteName | The name of the site for the study | The name of the site for the study | Site Name | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Migraine History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C54384 | Headache neurological symptom before during type | HdacheNeuroSympBefDurTyp | The element related to the type of neurological symptoms before and/or during headache | The element related to the type of neurological symptoms before and/or during headache | Do you have neurological symptoms immediately before and/or during your headache? | Visual scotoma;Visual hallucination;Weakness or numbness on one side of the body | Visual scotoma (blind or black spots);Visual hallucination (zig zag or wavy lines, colored lights or balls, shimmering patterns);Weakness or numbness on one side of the body | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-06 08:20:12.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C19247 | Subject ID | SubIDNam | Subject identification ID | Subject identification ID | Site Name | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-06-05 13:10:49.0 | Migraine History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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C54385 | Migraine headache pain symptom type | MigrHeadachePainSymptmTyp | The element related to the type of pain symptoms the participant/subject experiences with migraine headaches | The element related to the type of pain symptoms the participant/subject experiences with migraine headaches | Do you have any of these symptoms with headache? | Pain on one side of head only;Pain made worse by routine activity;Pain limits or restricts routine activities;Throbbing or pulsing pain sensation | Pain on one side of head only;Pain made worse by routine activity;Pain limits or restricts routine activities;Throbbing or pulsing pain sensation | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C19256 | Study protocol name | StudyProtocolName | Name of study protocol | Name of study protocol | Study Name/ID pre-filled | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-06-05 16:38:14.0 | Migraine History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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C54386 | Migraine headache symptom type | MigrHeadacheSymptmTyp | The element related to the type of pain symptoms the participant/subject experiences with migraine headaches | The element related to the type of pain symptoms the participant/subject experiences with migraine headaches | Do you have any of these symptoms with your headache? | Nausea/vomiting;Increased sensitivity to normal light AND sound;Pain on one side of head only;Throbbing or pulsing pain sensation;Pain limits or restricts routine activities;Pain made worse by routine activity | Nausea/vomiting;Increased sensitivity to normal light AND sound;Pain on one side of head only;Throbbing or pulsing pain sensation;Pain limits or restricts routine activities;Pain made worse by routine activity | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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C53072 | Migraine headache indicator | MigraineHeadacheInd | Indicator as to whether the participant/subject has a medical history of migraine headache | Indicator as to whether the participant/subject has a medical history of migraine headache | Personal history of migraine headache | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C54387 | Headache prior treatment indicator | HeadachPriorTxInd | Indicator related to prior treatment for headache | Indicator related to prior treatment for headache | Prior treatment for headache? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17022 | Migraine Disability Assessment (MIDAS) - School work absent past three month day count | MIDASSchoWorkAbsPast3MDayCt | Number of days in the last three months the participant/subject has missed work or school because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | Number of days in the last three months the participant/subject has missed work or school because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | On how many days in the last 3 months did you miss work or school because of your headaches? | Numeric Values |
If you're not working or going to school, just enter 0. |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | |||||||||
C54373 | Headache past three month alcohol substance use unrelated indicator | HdachePstThrMoAlcSubUseUnrlInd | Indicator for whether the participant/subject has had a headache in the past three months that is unrelated to alcohol/substance use | Indicator whether participant/subject has had a headache in the past three months that is unrelated to alcohol/substance use | Have you had one or more headaches in the past 3 months, unrelated to alcohol/substance use? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-03 15:56:09.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C54388 | Migraine headache family history indicator | MigrHeadacheFamHisInd | Indicator as to whether the participant/subject has a family history of migraine headache | Indicator as to whether the participant/subject has a family history of migraine headache | Any family history of migraine headaches | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17023 | Migraine Disability Assessment (MIDAS) - School work productivity reduction past three months day count | MIDASSchlWrkProRedP3MDayCt | Number of days in the last three months the participant/subject has experienced productivity reduction by half or more while at work or school because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | Number of days in the last three months the participant/subject has experienced productivity reduction by half or more while at work or school because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | How many days in the last 3 months was your productivity at work or school reduced by half or more because of your headaches? | Numeric Values |
If you're not working or going to school. Just enter 0. (Do not include days you counted in question 1 where you missed work or school). |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | |||||||||
C54374 | Headache start within two week concussion indicator | HdacheStrtWithnTwoWkConcussInd | Indicator for whether the participant/subject has had headaches that started within two weeks of concussion | Indicator for whether the participant/subject has had headaches that started within two weeks of concussion | Did headaches start within 2 weeks of concussion? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-03 15:56:09.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17024 | Migraine Disability Assessment (MIDAS) - Household work not done past three months day count | MIDASHshldNotDoneP3MDayCt | Number of days in the last three months the participant/subject has not done household work because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | Number of days in the last three months the participant/subject has not done household work because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | On how many days in the last 3 months did you not do household work because of your headaches? | Numeric Values |
INSTRUCTIONS: Please answer the following questions about ALL your headaches you have |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | |||||||||
C54376 | Brain abnormality indicator | BrainAbnormalInd | The indicator related to brain abnormalities | The indicator related to brain abnormalities | Do you have any brain abnormalities? | No;Yes | No;Yes | Alphanumeric |
(unrelated to concussion) |
Adult;Pediatric | Supplemental | 1.00 | 2016-12-04 23:35:32.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17025 | Migraine Disability Assessment (MIDAS) - Household work productivity half reduction past three months day count | MIDASHshldWrkProHReP3MCt | Number of days in the last three months the participant/subject has experienced productivity reduction by half or more while doing household work because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | Number of days in the last three months the participant/subject has experienced productivity reduction by half or more while doing household work because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | How many days in the last 3 months was your productivity in household work reduced by hald or more because of your headaches? | Numeric Values |
Do not include days you counted in question 3 where you did not do household work). |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | |||||||||
C54379 | Headache daily occurrence indicator | HdacheDailyOccurInd | The indicator related to whether the participant/subject has a headache every day | The indicator related to whether the participant/subject has a headache every day | Do you have a headache every day? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-12-04 23:35:32.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17026 | Migraine Disability Assessment (MIDAS) - Activity missed past three months day count | MIDASActMissP3MDayCt | Number of days in the last three months the participant/subject has missed family, social, or leisure activities because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | Number of days in the last three months the participant/subject has missed family, social, or leisure activities because of their headaches, as part of the Migraine Disability Assessment (MIDAS) Test form. | On how many days in the last 3 months did you miss family, social or leisure activities because of your headaches? | Numeric Values |
INSTRUCTIONS: Please answer the following questions about ALL your headaches you have |
Innovative Medical Research, 1997 2007, AstraZeneca Pharmaceuticals, LP. All Rights reserved. | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | |||||||||
C54381 | Headache pain medication more than four days week indicator | HdachPainMedMoreFourDysWkInd | Indicator for whether the participant/subject takes headache pain medication more than four days per week | Indicator for whether the participant/subject takes headache pain medication more than four days per week | Do you take over the counter or pescription pain or headache medication more than 4 days per week? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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C17028 | Migraine Disability Assessment (MIDAS) - Headache past three months day count | MIDASHdacheP3MDayCt | Count the total number of days in the past three months the participant/subject had headache, as part of the Migraine Disability Assessment (MIDAS) Test form. | Count the total number of days in the past three months the participant/subject had headache, as part of the Migraine Disability Assessment (MIDAS) Test form. | On how many days in the last 3 months did you have a headache? | Numeric Values |
If a headache lasted more than 1 day, count each day. |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Migraine History | General Health History | Participant History and Family History |
Free-Form Entry |
day | ||||||||||
C54382 | Headache chronicity type | HeadacheChronicityTyp | The type as related to headache chronicity | The type as related to headache chronicit | Do you have intermittent or constant headache? | Intermittent;Chronic | Intermittent;Chronic | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2016-06-02 15:04:05.0 | Migraine History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |