Migraine Quiz Questions
After carefully evaluating hundreds of his own migraine patients and consulting on thousands more, Dr. Jensen has developed a quick 5 minute quiz to determine if his program can help you find relief from your migraine headaches.
Email address *
1. What is your name? *
Your answer
2. Are you male or female? *
Your answer
3. How old are you? *
Your answer
4. How long have you been suffering from migraines? *
Your answer
5. How old were you when you had your first migraine? *
Your answer
6. How often do you have migraines? *
Your answer
7. Do you get other types of headaches? *
Your answer
8. Did you suffer any physical or emotional trauma prior to your first migraine? *
Your answer
9. Do certain foods trigger your migraines? *
Your answer
10. If you're female, do your migraines coincide with your monthly cycle? *
Your answer
11. Do you have jaw pain? *
Your answer
12. Have you been involved in a car accident or suffered a neck injury? *
Your answer
13. When your migraines come on, do you have visual problems as well? *
Your answer
14. Do your migraines cause nausea, dizziness or fainting? *
Your answer
15. When you have a migraine is the pain in your entire head or on one side or the other? If it's on one side which side and is it always the same? *
Your answer
16. What treatments have you tried to help with your migraines? Have they worked at all? *
Your answer
17. How are your migraines interfering with your home life? Your work life? Your social life? *
Your answer
18. How interested are you in finding a natural solution for your migraines? *
Your answer
19. Are you OK if someone calls you with information about a complimentary consultation? *
20. If you answered yes to the above question, what is your phone number?
Your answer
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