O2 Survey

Heritability of Cluster Headaches

If you suffer from Cluster Headaches please take a moment to complete this survey about the history of headaches in your family.

The results of this survey will be shared with medical professionals to help determine if there is a genetic factor that contributes to cluster headaches.

If you don't see some of your answers on the "Results" page, don't worry, you completed the survey correctly. Some answers cannot be shown because of the way the program operates. Your responses were received and will be used when we analyze the results.

Your General Information
1. What is your sex?	female male

2. What year were you born?	year of birth

3. How old were you when your headaches started?	age at onset

4. Have you been medically diagnosed with cluster headaches?	yes no

5. If not medically diagnosed, do you believe you have cluster headaches?	yes no (stop, do not complete the rest of this survey) NA

6. Are your clusters episodic or chronic?	episodic chronic

7. Do you also suffer from other types of headaches such as migraine or CPH?	yes type/s no
This Section Deals With your Immediate Family
8. Do any of your sons have:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no

9. Do any of your daughters have:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no
This Section Deals With Your Generation
10. Do any of your brothers have:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no

11. Do any of your sisters have:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no
This Section Deals With Your Parents Generation
12. Has your Father ever had:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no

13. Have any of your Father's brothers or sisters (your paternal Aunts or Uncles) ever had:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know

14. Has your Mother ever had:
cluster headaches?	yes no
migraines?	yes no
other severe headaches of unknown type?	yes no

15. Have any of your Mother's brothers or sisters (your maternal Aunts or Uncles) ever had:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know
This Section Deals With Your Grandparent's Generation
Mother's Side of the Family:
16. Did your maternal Grandfather ever have:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know

17. Did your maternal Grandmother ever have:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know

Father's Side of the Family:
18. Did your paternal Grandfather ever have:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know

19. Did your paternal Grandmother ever have:
cluster headaches?	yes no don't know
migraines?	yes no don't know
other severe headaches of unknown type?	yes no don't know
Other Information
20. Are you aware of any other relatives who suffered from severe headaches?	relative and type of headache

Optional Information
E-mail Address
Comments: