IF RATED 1 OR 2 ASK Q180 OTHERWISE SKIP TO Q181 Q180 Where? What are they like? (How Q180 Tension headaches are rated here. often)? RATE FOR TENSION These are usually expressed as bands HEADACHES. around the head, pressure, tension in the back of the neck or tightness, or pressure 0. No upon the top of the head. They are not 1. Mild localised to one side of the head as in 2. Severe migraine and they are not accompanied by 8. No answer visual disturbances or nausea. They are not 9. Not asked usually made worse by leaning forward or by rapid movement of the head. In addition, tenderness is sometimes complained of in these areas, especially to the touch of a comb. CEREBROVASCULAR FUNCTION Q181 Do you often feel dizzy? 0. No or rarely 1. More than once per week 8. No answer 9. Not Q182 Do you have a tendency to fall? 0. No or rarely 1. More than once per month 8. No answer 9. Not asked Q183 Have you ever suffered from attacks of dizziness in which things seem to spin around you? 0. No 1. Yes within the last year 2. Yes, more than 1 year ago Q184 Have you ever suffered from... unsteadiness, light headedness or feeling faint? 0. No
IF RATED 1 OR 2 ASK Q180 OTHERWISE SKIP TO Q181 Q180 Where? What are they like? (How often)? RATE FOR TENSION HEADACHES. 0. No 1. Mild 2. Severe 8. No answer 9. Not asked Q180 Tension headaches are rated here. These are usually expressed as bands around the head, pressure, tension in the back of the neck or tightness, or pressure upon the top of the head. They are not localised to one side of the head as in migraine and they are not accompanied by visual disturbances or nausea. They are not usually made worse by leaning forward or by rapid movement of the head. In addition, tenderness is sometimes complained of in these areas, especially to the touch of a comb. CEREBROVASCULAR FUNCTION Q181 Do you often feel dizzy? 0. No or rarely 1. More than once per week 8. No answer 9. Not Q182 Do you have a tendency to fall? 0. No or rarely 1. More than once per month 8. No answer 9. Not asked Q183 Have you ever suffered from attacks of dizziness in which things seem to spin around you? 0. No 1. Yes within the last year 2. Yes, more than 1 year ago Q184 Have you ever suffered from... unsteadiness, light headedness or feeling faint? 0. No
CFAS-II-questionnaire-part-1-v5-111008.docx