APNEA-SNORING.COM 

THE WEBSITE OF ALLEN J. MOSES, DDS

SEARS TOWER - CHICAGO

HEADACHE SURVEY
Acute / Chronic Headache Survey

While headaches may often accompany sleep problems it is important to initially distinguish between acute and chronic headaches. Certain acute headaches are emergency situations that may be life-threatening.  If you have a sleep problem and get headaches, and you answer yes to one or more questions it is suggested that you print this form and discuss your responses with your primary care physician.  IF YOU ARE EXPERIENCING ACUTE HEADACHES, PLEASE CONTACT YOUR PHYSICIAN IMMEDIATELY.

Carefully consider the following questions (Circle Yes or No to answer):

Have you been getting your headaches
for six months or less?                                        YES     NO

Is this the first time you have had this
type of severe headache?                                    YES     NO

Do you have a fever with your headache?               YES     NO

Do you have a stiff neck and fever with
your headache?                                                  YES     NO

Do you get severe headaches that have
been getting progressively worse?                         YES     NO

Do you get severe headaches with sudden
onset that originated in the last six months?          YES     NO

Do you ever pass out when you get a headache
or suffer loss of any of your senses?                      YES     NO

Did your headache problem begin after trauma
or an injury that took place in the last six months?  YES     NO
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