Case Study Application
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About
This is the Case Study application form for MigrainePal.

On behalf of the MigrainePal community and migraine patients everywhere, thank you!
Instructions
Imagine you have been written these questions by a close friend who has just told you they have been diagnosed with migraine. Your responses will help guide them with their condition.  

This application is one page. Most questions are multiple choice and straightforward. There are only one or two open response questions.

Answer every question in full and to the best of your ability. Please be as honest as you can. If the responses are not true to the best of your ability then there is little value participating.

If you have questions please visit our FAQ page at www.blog.migrainepal.com/casestudyFAQ
Gender *
Where are you from? *
City, Country (i.e. Venice, Italy)
Age when you had your first migraine? *
Enter a number (not your current age unless your first migraine was this year)
Years with migraine? *
Enter a number. If the answer is 2.5 years ago then enter "2.5" for example
How many days with migraine do you currently experience on average per month? *
If you currently have 3 migraines a month lasting 2 days each on average, that equals 6 days a month of migraine.
What are your known migraine triggers or causes? *
Select at least one or more from the below.
Required
Is your migraine frequency getting better, worse or steady?
This indicates the positive or negative trend in your current migraine condition.
Clear selection
If better or worse, how many days were you previously averaging per month with migraine? *
If you're still the same, simply write "same". Otherwise enter the previous number of migraines days per month.
What do you think has been the key factor in this result? *
What is the reason why you are progressing in this direction?
What treatments have you taken for your migraines? (checkbox) *
Medications are listed first by the generic name then by their brand name in brackets. Not all brand names are listed. Non medicinal treatments, remedies & precautionary behaviours are also listed.
Required
Which treatments did you find most beneficial? *
List your shortlist of treatments from the above list.
What advice would you give to others with migraine? *
What is the most important fact or lesson others should know?
First Name *
i.e. Jane.
Last Name *
i.e. Simpson. We ask for your full name as it makes the case study more credible.  If you are concerned about privacy then use your middle name or a maiden name here which will help retain your privacy.
Follow Up

YOUR CONTACT DETAILS WILL REMAIN STRICTLY PRIVATE & CONFIDENTIAL.

Should significant editorial changes, permission or contact be required.
Email address *
Phone number
Terms Agreement
The goal of this case study collection is to help as many migraineurs as possible. We are undertaking this in good faith to benefit the community. To do achieve this you freely grant us your permission to distribute this content in any format without further permission or payment.  

If you make a mistake or grammatical error, we have an editor who will review the grammar of each application. We will never change the facts of your case study. You grant us permission to make modest grammatical changes where required to your answers.

MigrainePal is entirely self-funded by a small group of migraineurs, supporters and volunteers. We have a clean site policy and do not accept advertising or sponsorships. We may use the case study collection to publish for sale. Any funds received will remain the sole property of MigrainePal and reinvested back into supporting the community. You give up your right to any future funds as a result of sales or fund raisers that the case study collection may generate.
Terms Agreement *
Required
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