Headache Research Survey

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Our mission is to accelerate biomedical research by putting patients first.

How will your patient insights be used?
Your insights may inform future research studies. Hearing from you helps us design research that meets your needs.
Learn more about us; contact us.

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* 1. What is your age?

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* 2. What state do you reside in?

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* 3. Do you suffer from any of the following headache conditions? Check all that apply.

Migraine headaches (severe, throbbing headaches that often cause nausea and light and sound sensitivity; to cope, patients lie still in dark, quiet rooms)

Cluster headaches (excruciating constant pain, always on one side of the head, that causes agitation; patients cannot sit still or lie down)

N/A

Other (please specify):

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* 4. Have you been diagnosed by a healthcare professional with any of the following headache conditions? Check all that apply.

Migraine headaches

Cluster headaches

N/A

Other (please specify):

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* 5. How would you characterize the severity of your headache condition?

Mild

Moderate

Severe

Excruciating

N/A

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* 6. How frequently do you suffer from headache attacks?

Once a day

2–3 times per week

Once a week

1–2 times per month

1–2 times per year

N/A

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* 7. How long do your headaches last?

Less than 4 hours

4–24 hours

1–3 days

Longer than 3 days

N/A

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* 8. Are you currently receiving medical help or taking any medications for your headaches?

Yes

Sometimes

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* 9. Would you be interested in participating in headache research studies?

Yes

I don't know

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* 10. If you've been diagnosed with cluster headaches or migraine headaches, can you describe your experience living with this condition?

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* 11. What is your race/ethnicity? Check all that apply.

Alaskan Native / American Indian / Native American

Asian / Asian-American

Black / African-American

Native Hawaiian / Pacific Islander

Hispanic / Latinx/a/o / Spanish origin

White

Prefer not to say

Prefer to self-describe (Please fill in)

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* 12. What is your gender?

Female

Male

Non-binary / third gender

Prefer not to say

Prefer to self-describe (Please fill in)

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* 13. Can we reach out to you for more information?

By checking this box, I agree to be contacted about my experiences with headaches and about potential Science 37 research studies for people with headaches. Science 37's Privacy Policy.

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* 14. Contact Information

First Name

Last Name

Email Address

Phone Number

Zip Code