Please enter your name
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Title
First Name
Last Name
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Do you have frequent or intense headaches?
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Yes
No
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Do you usually suffer from nausea when you have a headache?
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Yes
No
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Do your headaches usually last more than four hours?
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Yes
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Does light or noise bother you when you have a headache?
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Yes
No
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Do your headaches limit any of your physical or intellectual activities?
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Yes
No
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