CDE Detailed Report

Disease: Headache
Sub-Domain: Imaging Diagnostics
CRF: Nociceptive Blink Reflex and Pain-Related Evoked Potentials

Displaying 1 - 25 of 25
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
C55778 Imaging inter peri ictal next headache start duration ImagInterPeriIctNextHeStartDur The duration of time until the start of the subject's next inter-ictal or peri-ictal headache. The duration of time until the start of the subject's next inter-ictal or peri-ictal headache. If inter-ictal or peri-ictal, duration of time until start of next headache (include units) Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:23:34.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C15544 Imaging stimulation intensity value ImgStimlIntenVal Stimulation intensity used on imaging. Stimulation intensity used on imaging. Stimulation intensity (include units) Numeric Values

Not more than 2.0mA; Include units

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C55783 Imaging evoked potential (EV) laser nociceptive stimulation manufacturer name ImgEVLaserNcptveStmnMaNam The name of the laser nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test The name of the laser nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test Manufacturer Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C15551 Imaging evoked potential stimulus type ImgEVStimulusTyp Type of stimulus used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test Type of stimulus used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test Stimulus Single pulse;Double pulse;Triple pulse Single pulse;Double pulse;Triple pulse Alphanumeric

Triple pulse is suggested

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Single Pre-Defined Value Selected

C55784 Imaging evoked potential (EV) laser nociceptive stimulation model name ImgEVLaserNcptveStmnMNam The name of the laser nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test The name of the laser nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test Model Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C15552 Imaging stimuli duration ImgStimuliDur Duration of stimuli used on imaging test. Duration of stimuli used on imaging test. Duration of stimuli Numeric Values

Record in 1000 microseconds

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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millisecond
C55785 Imaging evoked potential (EV) Chemical nociceptive stimulation method name ImgEVChemNcptveStmnMeNam The name of the chemical nociceptive stimulation method used as part of the Blink Reflex and Evoked Potential Imaging test The name of the chemical nociceptive stimulation method used as part of the Blink Reflex and Evoked Potential Imaging test Method Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C02411 Laterality type LatTyp Laterality type relative to the anatomic site of the body examined or affected Laterality type relative to the anatomic site of the body examined or affected Stimulation side Left;Right;Bilateral Left;Right;Bilateral Alphanumeric

(e.g. pain side)

No references available Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Single Pre-Defined Value Selected

C15554 Imaging evoked potential interpulse interval 5ms value ImgEVInterpulseIntrvl5MsVal Interpulse interval at 5ms used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test Interpulse interval at 5ms used on participant/subject as part of the Blink Reflex and Evoked Potential Imaging test Interpulse intervals Numeric Values

No additional instructions

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C55786 Imaging evoked potential (EV) Chemical nociceptive stimulation substance name ImgEVChemNcptveStmnSubNam The name of the chemical nociceptive stimulation substance used as part of the Blink Reflex and Evoked Potential Imaging test The name of the chemical nociceptive stimulation substance used as part of the Blink Reflex and Evoked Potential Imaging test Substance Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C02494 Imaging study date and time ImgStdyDateTime Date (and time, if applicable and known) the radiologic study was obtained. Date (and time, if applicable and known) the radiologic study was obtained. Date of test Date or Date & Time

Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.).

No references available Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C15562 Imaging total pulse count ImgTotalPulseCt Total number of pulses used on imaging. Total number of pulses used on imaging. Total number of averaged responses Numeric Values

15-20 pulses suggested

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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pulse
C55787 Imaging evoked potential (EV) recording parameter type ImagEVRecordParaTyp The type of recording parameter used for the imaging, as part of the Blink Reflex and Pain-Related Evoked Potentials Test. The type of recording parameter used for the imaging, as part of the Blink Reflex and Pain-Related Evoked Potentials Test. Recording parameters bandwidth (low-high);sweep length (in ms);sampling rate (in kHz) bandwidth (low-high);sweep length (in ms);sampling rate (in kHz) Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-31 13:41:51.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Multiple Pre-Defined Values Selected

C15523 Imaging evoked potential technique type ImgEVTechniqueTyp Type of technique the participant/subject used as part of the Blink Reflex and Evoked Potential Imaging test Type of technique the participant/subject used as part of the Blink Reflex and Evoked Potential Imaging test Technique nBR;PREP nBR;PREP Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Multiple Pre-Defined Values Selected

C15573 Imaging stimulation target type ImgStimlTargetTyp The type of stimulation target of the imaging test. The type of stimulation target of the imaging test. Stimulation target V1;V2;V3 V1;V2;V3 Alphanumeric

No additional instructions

Rossi S, Hallett M, Rossini PM, et. Al. and The Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology 2009;120:2008-2039. Wasserman EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalography and Clinical Neurophysiology 1998;108:1-16. Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Single Pre-Defined Value Selected

C55788 Imaging evoked potentials (EV) averaged response sequential block responses per block number ImagEVAvgRespnsSeqBloPerBloNum The number of sequential blocks of averaged responses and the number of responses in each block, as part of the Blink Reflex and Pain-Related Evoked Potentials Imaging test. The number of sequential blocks of averaged responses and the number of responses in each block, as part of the Blink Reflex and Pain-Related Evoked Potentials Imaging test. Number of sequential blocks of averaged responses & number of responses in each block Numeric Values

Indicated whether block averaging is used, number per block and interval between blocks.

Adult;Pediatric Supplemental 1.00 2017-05-31 13:52:24.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C15525 Imaging evoked potential electrical nociceptive stimulation manufacturer name ImgEVElctrclNcptveStmnMaNam The name of the electrical nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test The name of the electrical nociceptive stimulation manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test Manufacturer Alphanumeric

Indicate equipment manufacturer and model

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C55774 Imaging headache relation time type ImagHeadacheRelTimeTyp The type of timing of the imaging in relation to headache. The type of timing of the imaging in relation to headache. Stimulation timing Inter-Ictal;Ictal;Peri-Ictal Inter-Ictal;Ictal;Peri-Ictal Alphanumeric

Report the timing of the study in relation to the headache. The precise time windows of peri-ictal and inter-ictal vary with headache type. For episodic migraine, an interval of at least 72h from the last and before the next attack is generally accepted as "inter-ictal".

Adult;Pediatric Supplemental 1.00 2017-05-31 12:14:56.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

Single Pre-Defined Value Selected

C15530 Imaging evoked potential electrical nociceptive stimulation model name ImgEVElctrclNcptveStmnMNam The name of the electrical nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test The name of the electrical nociceptive stimulation model used as part of the Blink Reflex and Evoked Potential Imaging test Model Alphanumeric

Indicate equipment manufacturer and model

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C55775 Imaging ictal pain intensity value ImagIctPainIntensVal The value related to the intensity of the subject's pain if the timing is ictal The value related to the intensity of the subject's pain if the timing is ictal If ictal, pain intensity at time of recordings Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:19:15.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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0 10
C15531 Imaging evoked potential stimulation frequency value ImgEVStimulationFreqVal The stimulation frequency used on the participant/subject as part of the Blink Reflex and Evoked Potential Imaging test The stimulation frequency used on the participant/subject as part of the Blink Reflex and Evoked Potential Imaging test Stimulation frequency (include units) Numeric Values

Suggested one stimulus every 20 seconds. Include units

Rossi S, Hallett M, Rossini PM, et. Al. and The Safety of TMS Consensus Group. Safety, ethical considerations, and application guidelines for the use of transcranial magnetic stimulation in clinical practice and research. Clinical Neurophysiology 2009;120:2008-2039. Wasserman EM. Risk and safety of repetitive transcranial magnetic stimulation: report and suggested guidelines from the International Workshop on the Safety of Repetitive Transcranial Magnetic Stimulation, June 5-7, 1996. Electroencephalography and Clinical Neurophysiology 1998;108:1-16. Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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Hertz
C55776 Imaging ictal headache since onset duration ImagIctHeadSinceOnsetDur The duration of time since the onset of the subject's headache if it was ictal. The duration of time since the onset of the subject's headache if it was ictal. If ictal, duration of time since onset of headache (include units) Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:21:21.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C15535 Imaging evoked potential recording system manufacturer name ImgEVRecordingSystemManufNam The name of the recording system manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test The name of the recording system manufacturer used as part of the Blink Reflex and Evoked Potential Imaging test Manufacturer Alphanumeric

Indicate equipment manufacturer and model

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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C55777 Imaging inter peri ictal headache since end duration ImagInterPeriIctHeadSincEndDur The duration of time since the end of the subject's last inter-ictal or peri-ictal headahe. The duration of time since the end of the subject's last inter-ictal or peri-ictal headahe. If inter-ictal or peri-ictal, duration of time since end of last headache (include units) Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:23:34.0 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations

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C15542 Imaging evoked potential recording system model name ImgEVRecordingSystemMoNam The name of the recording system model used as part of the Blink Reflex and Evoked Potential Imaging test The name of the recording system model used as part of the Blink Reflex and Evoked Potential Imaging test Model Alphanumeric

Indicate equipment manufacturer and model

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Nociceptive Blink Reflex and Pain-Related Evoked Potentials Imaging Diagnostics Assessments and Examinations 255

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CSV