CDE Detailed Report

Disease: Headache
Sub-Domain: History of Disease/Injury Event
CRF: Medical and Family History of Headache

Displaying 1 - 13 of 13
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 / 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
C16025 Family history second-degree physician diagnosis count FamHistScndDegPhyscnDiagnsCt The number of second-degree relatives with the medical condition confirmed by a physician The number of second-degree relatives with the medical condition confirmed by a physician Number of second degree relatives number with physician diagnosis. Numeric Values

If there is a history of this condition in the family, indicate the total number of relatives with a history of the condition, the number of relatives affected (patient reported diagnosis), and if the number of relatives that were diagnosed by a physician.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

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 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 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C16208 Family history medical condition second-degree relative type FamHistMedclCondScndDegReltTyp Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject Relationship of relative(s) to participant/subject 11;12;13;14;15;16;17;18;19;20;21;22;23;24 Half-Sibling Male;Half-Sibling Female;Maternal Grandmother;Maternal Grandfather;Paternal Grandmother;Paternal Grandfather;Maternal Aunt;Maternal Uncle;Paternal Aunt;Paternal Uncle;Grandchild Male;Grandchild Female;Nephew;Niece Numeric Values

Separate multiple codes with comma

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C17992 Additional comment text AddtnalCommntTxt Text describing any additional information about the participant or the participant's family history Text describing any additional information about the participant or the participant's family history Additional Comments Alphanumeric

Record any pertinent information regarding the participant/subject, and/or family in the comments filed.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C19039 Headache migraine other text HdchMigranOTH The free-text field related to 'Headache migraine type' specifying other text. Type of headache or migraine The free-text field related to 'Headache migraine type' specifying other text. Type of headache or migraine Other, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events 4000

Free-Form Entry

C00721 Family history medical condition indicator FamHistMedclCondInd Indicator of whether a family member or first and second degree blood relatives of the participant/subject has had a history of the particular medical condition or health related event Indicator of whether a family member or first and second degree blood relatives of the participant/subject has had a history of the particular medical condition or health related event Relative affected (first and second-degree relatives ONLY)? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

3165788
C56045 Headache migraine physician diagnosis medical documentation indicator HdachMgrnPhyscnMdclDcmntatnInd Indicator of whether the participant/subject has a physician diagnosis or medical documentation of headaches or migraines Indicator of whether the participant/subject has a physician diagnosis or medical documentation of headaches or migraines Physician diagnosis or medical documentation supporting diagnosis? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C16005 Headache migraine type HeadachMigranTyp Type of headache or migraine Type of headache or migraine Diagnosis Migraine with aura;Migraine without aura;Chronic Migraine;Hemiplegic Migraine;Menstrual Headache;Tension Type Headache;Episodic Tension Type;Chronic Tension Type;Trigeminal Autonomic Cephalgias;Cluster Headache;Trigeminal Headache;Other TAC type, specify;Other primary type headache, specify;Other secondary type headache, specify Migraine with aura;Migraine without aura;Chronic Migraine;Hemiplegic Migraine;Menstrual Headache;Tension Type Headache;Episodic Tension Type;Chronic Tension Type;Trigeminal Autonomic Cephalgias (TACS);Cluster Headache;Trigeminal Headache;Other TAC (Trigeminal Autonomic Cephalgia) type, specify;Other primary type headache, specify;Other secondary type headache, specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C56046 Headache migraine participant affected condition indicator HdachMgrnPrtcpntAffctdCndtnInd Indicator of whether the participant/subject has been affected by their condition related to headaches or migraines Indicator of whether the participant/subject has been affected by their condition related to headaches or migraines Participant affected by condition? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C16006 Family history first-degree physician diagnosed count FamHist1stDegPhyscnDiagnsCt The number of first-degree relatives with the medical condition confirmed by a physician The number of first-degree relatives with the medical condition confirmed by a physician Number of first degree relatives number with physician diagnosis Numeric Values

If there is a history of this condition in the family, indicate the total number of relatives with a history of the condition, the number of relatives affected (patient reported diagnosis), and if the number of relatives that were diagnosed by a physician.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C16010 Headache migraine diagnosis indicator HeadachMigranDiagnsInd Indicator of whether the participant/subject has been diagnosed with the type of headache or migraine Indicator of whether the participant/subject has been diagnosed with the type of headache or migraine Participant/subject diagnosed? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If the participant/subject has a history of this condition, indicate yes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C16019 Family history relative first-degree affect count FamHistReltv1stDegAffctCt The number of first-degree relatives affected with the medical condition. The number of first-degree relatives affected with the medical condition. Number of first degree relatives number affected Numeric Values

If there is a history of this condition in the family, indicate the total number of relatives with a history of the condition, the number of relatives affected (patient reported diagnosis), and if the number of relatives that were diagnosed by a physician.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C16021 Family history second-degree relative affected count FamHistScndDegReltvAffctCt The number of second-degree relatives affected with the medical condition. The number of second-degree relatives affected with the medical condition. Number of second degree relatives number affected. Numeric Values

If there is a history of this condition in the family, indicate the total number of relatives with a history of the condition, the number of relatives affected (patient reported diagnosis), and if the number of relatives that were diagnosed by a physician.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Medical and Family History of Headache/Migraine History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

CSV