In an average month, how often do you experience migraines or severe headaches?
0-4
5-9
10-14
15+
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Have you previously been diagnosed with chronic migraines by a medical provider?
Yes
No
How long have you been trying different migraine treatments?
Less than 6 months
6 months - 11 Months
12+ Months
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Do you currently have any of the following conditions?
Blood clotting disorders
Cardiovascular Issues
Seizure disorders
Diabetes
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What migraine treatments have you tried?
Prescription Medications
Acupuncture
Botox injections
Nerve blocker injections
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Have you been diagnosed with any of the following?
Migraine (General)
Hemiplegic Migraine
Tension Headache
Occipital Neuralgia
Headache After Trauma
Trigeminal Neuralgia
Other
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