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© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacp

© Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 1 ASSOCIATED SYMPTOMS Migraine Conversation Guide Having to live with chronic pain is difficult enough without the added burden of migraine headaches. This guide will help you to have a meaningful conversation with your health care provider. Use this tool before you go to your next appointment. Pain level 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 None Extreme 10-20 20-30 40-50 60-70+ 50-60 Young Later in life Age onset Frequency of headaches per month None None 10 or more All the time Any associated with aura Nausea None Severe nausea Sweating None Sweating Supported by a grant from 30-40 © Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 2 Migraine Conversation Guide Blood shot eyes 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 0 1 2 3 4 5 6 9 7 8 10 None Severely blood shot Sensitivity to light Sensitivity to sound None None None Extreme sensitivity Extremely sensitive Extreme mood swings Mood changes Congestion None Severe congestion Supported by a grant from Smells None Extreme sensitivity 0 1 2 3 4 5 6 9 7 8 10 © Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 3 Migraine Conversation Guide Food Alcohol OTHER TRIGGERS (please list) Body Positions Weather Activity Chewing Coffee Environment/smells Hormone changes TRIGGERS OR MAKES PAIN WORSE Supported by a grant from ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Cold ❏ Hot ❏ Dry ❏ Other (specify) _______________________ ❏ Stormy ❏ Wet ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No ❏ Yes ❏ No 0 1 2 3 4 5 6 9 7 8 10 Sleep Disturbance None Severe insomnia Stress Noises ❏ Yes ❏ No © Copyright: 2015 The American Chronic Pain Association 800.533.3231 www.theacpa.org 4 Migraine Conversation Guide What Makes Pain Better (check all that apply) ❏ Ice ❏ Heat Treatments Tried (please list) ❏ Darkness ❏ Quiet ❏ Medication ❏ Sleep Supported by a grant from Select images © Can Stock Photo Inc. / julydfg / alejik / PILart / yupiramos / riedochse / yayayoyo / Krisdog / lenm / dejanj01 / vectorshots / CommercialCartoons / violetas uploads/Geographie/ acpa-migraine-guide.pdf