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EXPRESS YOUR MIGRAINE PAIN

1. Where is your pain?
(Indicate on body map)
Right

Left

Left

2. How long have you
been in pain?
Right< 6 months

6-12 Months

12-24 Months> 24 Months

3. How bad is your pain?
(1 = Faint , 10 = Debilitating)

Front

123

4

5678910Back

4. Which treatments have you tried to manage your pain?
Massage/Chiropractic

Physical Therapy

OTC Medications

Spinal Cord Stimulator

Prescription Medications

Surgery

Other:

5. Which activities are inhibited by your pain?

EatingHygeneChores

Sleep

Work

TravelLabor

Exercise

Relationships

Romance

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EXPRESS YOUR MIGRAINE PAINNo Pain

0NO PAIN

Mild Pain Level / Pain Score:
Does not interfere with most activities and iseasy to manage both physically andpsychologically. You can adapt to theselevels of pain with low doses of medication(eg. acetaminophen), dietary changes, or
bed rest.

1

FAINT PAIN

2

MILD PAIN

Examples:• Muscle sprain or strain• Muscle cramps

3

MODERATE PAIN

Uncomfortable Pain Leve/Pain Score
Interferes with many activities of daily living
and requires changes to daily lifestyle tomanage pain symptoms. Migraine pain ismore noticeable and it becomesincreasingly important to seek treatments.

4

UNCOMFORTABLE PAIN

5

DISTRACTING PAIN

6

DISTRESSING PAIN7

INTENSE PAIN

8

UNMANAGEABLE PAIN

9

SEVERE PAIN

10DEBILITATING PAIN

Examples• Extreme fatigue and body soreness• Hypertension• Hormone-related headache
Moderate migraine

Severe Pain Leve/Pain Score
At this stage you are no longer able toengage in normal activities and seeking
support from a caregiver, stronger
medications to help improve your ability tofunction independently.
Examples• Fatal drop in serotonin• Severe migraine headache• Severe temple pain
• Whiplash• Wry neck

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Your mobility and activities of daily living are in no way impacted. You feel no need toseek treatment or medical attention.

You are aware of the headache pain but it is very easy to ignore.

Uncomfortable but tolerable level of pain in your head that is noticeable but easy toforget or ignore over time. You are able to continue daily activities and your quality of life
is not yet impacted.

This level of throbbing head pain that is constantly on your mind. Over time anduntreated, this level of pain will impede your ability to live a normal life. Pain that has
started in your head and may be moving down your neck.

Piercing migraine pain that makes it di!cult to manage your activities of daily living.
The pain becomes consistently noticeable and you become more anxious andpsychologically impacted by your pain symptoms. You may experience weakness,blurred vision and radiating pain in your neck and head.

Migraine pain that controls your mindset and psychological outlook on your body’s ability
to recover. At this pain score, you are likely seeking clinical expertise for a diagnosis andtreatment regiment.

The level of radiating head pain is completely dominating your mindset and outlook on
recovery. You are reaching a point where your pain level is impeding your ability tooperate daily functions and cognitive thinking. Management of this level of pain requires
more medical expertise, prescription drugs, and the level of severity has you consideringexpert treatment and stronger medications.

Your pain is so intense that you can no longer think clearly and are experiencing
personality changes. Your head and neck are experiencing shooting pain that results innumbness, tingling, and extreme discomfort where it impedes your ability to be mobileand active.

This level of excruciating pain is so intense that you are unable to tolerate the level ofpain and are seeking stronger medications and emergency psychological intervention
to manage the pain.

This unimaginable level is so intense you may go unconscious. This type of pain is likely
incurred during a severe accident (eg. head injury) and your body is unable to recover on
its own. Emergency treatment is needed.

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