Migraine Clinical Outcome Assessment System (MiCOAS)
118-1
118-2
118-4
118-5
118-6
118-7
118-8
118-9
118-10
118-11
118-12
118-13
118-14
118-15
118-16
118-17
118-18
Are you an employee of the Food and Drug Administration, Albert Einstein College of Medicine, or Vector Psychometric Group?
Yes
No
Has a doctor or other healthcare professional ever told you that you have migraine?
Yes
No
Have you been interviewed or participated in a focus group for another research study about migraine in the past 12 months?
Yes
No
How old are you?
Less than 18 years old
18 –75 years
76 years old or older
Do you currently live in the United States?
Yes
No
Are you able to tell the difference between a day with migraine and days with other types of headaches?
Yes
No
Over the
last 3 months
, how many migraine headache days have you typically had
per month
?
0-3 headache days a month
4-8 headache days a month
9-14 headache days a month
15-20 headache days a month
21-26 headache days a month
More than 26 headache days a month
In the
last 3 months
, have you limited your activities on
at least 1 day
because of your migraine?
Yes
No
Has a doctor or other healthcare professional ever diagnosed you with any of the following? (Please check all that apply)
Multiple Sclerosis
Schizophrenia
Bi-polar disorder
Cognitive impairment
Alzheimer’s disease or dementia
Epilepsy
Traumatic brain injury or spinal cord injury
Stroke
None of the above
In the
last 30 days
, how often have you used an opioid (e.g., Percocet or OxyContin) or barbiturate (e.g., Fioricet or Seconal) medication, either for your migraine or for something else?
0-2 days
3-4 days
5-7 days
8-10 days
More than 10 days
Are you comfortable reading English, such as to read a newspaper or fill out a medical form on your own?
Yes
No
Would you be comfortable speaking English while talking to someone about your migraine for 60 minutes?
Yes
No
Over the
past 3 months
: Have you felt that you should cut down on your drinking or recreational drug use?
Yes
No
Over the
past 3 months
: Have people annoyed you by criticizing your drinking or recreational drug use?
Yes
No
Over the
past 3 months
: Have you felt guilty about your drinking or recreational drug use?
Yes
No
Over the
past 3 months
: Have you had a drink or taken recreational drugs first thing in the morning?
Yes
No
This study involves a single interview that takes up to 60 minutes. Are you willing to have your interview video recorded?
Yes
No