Philippine Neurological Association Confidential

Protocol: The PNA One Database Initiative Headache (PNA1DB - Headache)

4. STUDY DATA COLLECTION
Table 2. Study forms, data to be collected and data formats

Forms1 Headache Data Items Format Options / Other information

Subject ID number2 "H" + 3 letters, all caps + 6 H="Headache"

numbers HXXX000000 XXX= site ID
000000=sequential number for each site
Initials 3 letters, all caps FML=first, middle, last name; use "-" if no F, M, or L , e.g. F-L

Birthdate MMM-DD-YYYY MMM=first 3 letters of month, DD=numbers from 01 to 31,

YYYY=numbers from 1900 to 2050
Age Numbers, 2 digits
Sex (biological) radio button (one choice) male/female
Marital status radio button (one choice) Single/married/widowed/separated
Weight (in kg) Number, 3 digits
Height (in meters) Number, 3 digits
BMI (kg/m2) Number, 3 digits
Educational level Radio button (one choice) Elementary graduate/high school graduate/college
graduate/postgraduate/others (free text)
Employment Status radio button (one choice) Employed/self-employed/unemployed/retired

1
Anonymized
2
Study identification number assigned online in sequential order for each
site.

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

Latest occupation radio button (one choice) Managers/Professional/Technicians and associate

(International Standard
Classification of Occupations
major categories)
Age at onset of first headache
professionals/Clerical support workers/Service and sales
workers/Skilled agricultural, forestry and fishery workers/Craft
and related trades workers/Plant and machine operators, and
assemblers/Elementary occupations/Armed forces
occupations/Homemaker/others (free text)
Numbers, 2 digits

Sleeping Habits Radio button (one choice) Normal nighttime sleep (8PM-8AM)/Atypical daytime sleep
(8AM-8PM)

Hospital or clinic full name
(where data is collected)
Have you consulted a doctor
about your headache
What is the specialization of Drop down
the doctor that you consulted?
Number of consult/consults
for headache in the last 6
months
drop down Asian Hospital Medical Center/Baguio General Hospital/Jose Reyes
Memorial Medical Center/ Makati Medical Center/ Quirino Memorial
/University
of the East/ UP- Philippine General Hospital/University of Santo Tomas
radio button (one choice) yes/no
General practitioner/ Ophthalmologist/ optometrist/ ENT/
Neurologist/ Orthopedic Doctor/ Rehab doctor/ Others (free
text)
Numbers, 2 digits

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

Reason for consult Radio button (one choice) Persistent headache/recurrent headache/others (free text)

Headache Characteristics Radio button (multiple One sided/ Both sides/throbbing (pulsating)/pressing
choices) (tightening)/boring/sharp/shooting/pericranial
tenderness/heavy/neck pain/wakes me up//others (free text)

Location of the headache Radio button (multiple

choices)

1/2/3/4/5/6/7/8/910/11/12/13/14/others (free text)

Frequency of the headache Numbers 1 to 2 digits Per day/per week/per month/daily

Duration of headache Radio button (one choice) Seconds/minutes/hours/days/daily

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

Severity of headache Drop down No pain/little bit pain/little more pain/even more pain/much
more pain/worst pain

Symptoms before the Radio button (multiple Yes/no/describe (free text)

headache choice)
Symptoms during the Radio button (multiple Nausea/vomiting/sensitivity to light/sensitivity to noise/prefers
headache choices) to stay still/prefers to move/conjunctival injections/nasal
congestion/rhinorrhea/forehead and facial sweating/forehead
and facial flushing/others (free text)
Trigger factors Radio button (multiple Heat or cold/strenuous activity/menstruation/food and
choices) drinks/lack/too much sleep/stress/strong odors/hunger/others
(free text)
What do you do when you Radio button (multiple Nothing/consult a doctor/take medications/others (free text)
have headache? choices)
What medication do you Free text
usually take during an attack?
What is the effect of the drug Radio button (one choice Effective/initially effective but later not that effective/definitely
in your attack of headache? per drug) not effective/effective but with side effects

Have you tried taking Radio button (multiple Flunarizine/Topiramate/Valproic Acid/Propranolol/

preventive/prophylactic choices) Amitriptyline/ others (free text)
medications for your headache

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

Any diagnostic tests done? Radio button (multiple CT Scan/MRI/EEG/others (free text)
choices)

Medications prescribed to you Free text

before?
Are there any red flag signs? Radio button (multiple Systemic symptoms/ neurological signs and symptoms/ onset-
choices) thunderclap/ agrravated by valsalva/ older age of onset (>50)/
change in pattern of headache/ other (free text)

Diagnosis Radio button (one choice) Primary headache disorder/secondary heache disorder

Primary headache Disorder Radio Button Multiple Migraine without aura/migraine with aura/tension type
choices) headache/cluster headache/trigeminal autonomic
cephalalgia/others (free text)

Secondary headache disorder Free text

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

MIDAS On how many days Numbers, 1 to 2 digits

in the last three
1.
months did you miss
work or school
because your
headaches? How
many days in the
last three months
2.
was your
productivity at work
or school reduced
by half or more
because of your
headaches? (Do not
include days you
counted in question
1 where you missed
work or school.)
On how many days
3. in the last three
months did you not
do household work
because of your
headaches? How
many days in the
4. last three months
was your
productivity related
to household work
reduced by half of
more because of
your headaches?

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

(Do not include
days you counted in
question 3 where
you did not do
household work.)
5. On how many days
in the last three
months did you miss
family, social, or
leisure activities
because of your
headaches?
Depression I still enjoy the things I used to Radio button (one choice) 0 (Definitely as much) /1 (not quite so much) /2 (only a little) /3
enjoy (hardly at all)
I can laugh and see the funny Radio button (one choice) 0 (as much as I always could)/1 (not quite so much now)/ 2
side of things (definitely not so much now)/ 3 (not at all)
I feel cheerful Radio button (one choice) 0 (most of the time)/ 1 (sometimes)/ 2 (not often)/ 3 (not at all)
I feel as if I am slowed down Radio button (one choice) 0 (not at all)/ 1 (sometimes)/ 2 very often)/ 3 (nearly all the
time)
I have lost interest in my Radio button (one choice) 0 (I take just as much care as ever)/ 1 ( I may not take quite as
appearance
(definitely)
I look forward with enjoyment Radio button (one choice) 0 (as much as I ever did)/1 (rather less than I used to)/ 2
to things (definitely less than I used to)/ 3 (hardly at all)
I can enjoy a good book or Radio button (one choice) 0 (often)/ 1 (sometimes)/ 2 (not often)/ 3 (very seldom)
radio or TV program

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Protocol: The PNA One Database Initiative Headache (PNA1DB -Headache)

Forms1 Headache Data Items Format Options / Other information

Total score Numbers, 1 to 2 digits

Anxiety I feel tense or wound up Radio button (one choice) 0 (not at all)/ 1 (from time to time, occasionally)/ 2 (a lot of the
time)/ 3 (most of the time)

I get a sort of frightened Radio button (one choice)

feeling as if something awful is not too badly)/ 3 (very definitely and quite badly)
about to happen

Worrying thoughts go through Radio button (one choice) 0 (only occasionally)/ 1 (from time to time, but not too often)/ 2
my mind (a lot of the time)/ 3 (a great deal of the time)

I can sit at ease and feel Radio button (one choice) 0 (definitely)/ 1 (usually)/ 2 (not often)/ 3 (not at all)
relaxed

I get a sort of frightened Radio button (one choice) 0 (not at all)/ 1 (occasionally)/ 2 (quite often)/ 3 (very often)
feeling like butterflies in my
stomach
I feel restless as I have to be on Radio button (one choice0 0 (not at all)/ 1 (not very much)/ 2 (quite a lot)/ 3 (very much
the move indeed)

I get sudden feelings of panic Radio button (one choice) 0 (not at all)/ 1 (not very often)/ 2 (quite often)/ 3 (very often
indeed)

Total Score Numbers, 1 to 2 digits

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