Headache Disability Index

Full Name *

Today's Date: *

Section 1. INSTRUCTIONS: Please MARK the correct response:

I have a headache: *

1 per month

more than 1 but less than 4 per month

more than 1 per week

My headache is: *

Mild

Moderate

Severe

Section 1 Total

Section 2. INSTRUCTIONS: PLEASE READ CAREFULLY: The purpose of the scale is to identify difficulties that you may be experiencing because of your headaches. Please mark off “YES”, “SOMETIMES”, or “NO” to each item. Answer each item as it pertains to your headaches only.

Because of my headaches I feel handicapped. *

Yes

Sometime

No one understands the effect my headaches have on my life. *

Yes

Sometime

My spouse/significant other, or family and friends have no idea what I am going through because of my headaches. *

Yes

Sometimes

My headaches are so bad that I feel I am going to go insane.

Yes

Sometimes

Sometimes I feel that I am going to lose control because of my headaches. *

Yes

Sometimes

I am afraid to go outside when I feel a headache is starting. *

Yes

Sometimes

My headaches place stress on my relationships with family and friends. *

Yes

Sometimes

My headaches make me angry. *

Yes

Sometimes

My outlook on the world is affected by my headaches. *

Yes

Sometimes

My headaches make me feel desperate. *

Yes

Sometimes

My headaches make me feel frustrated. *

Yes

Sometimes

I feel irritable because of my headaches. *

Yes

Sometimes

I restrict my recreational activities (e.g. sports, hobbies) because of my headaches. *

Yes

Sometimes

My headaches make me feel confused. *

Yes

Sometimes

Because of my headaches I feel restricted in performing my routine daily activities. *

Yes

Sometimes

I avoid being around people when I have a headache. *

Yes

Sometimes

Because of my headaches I am less likely to socialize. *

Yes

Sometimes

I am unable to think clearly because of my headaches. *

Yes

Sometimes

I am concerned that I am paying penalties at work or at home because of my headaches. *

Yes

Sometimes

I believe my headaches are making it difficult for me to achieve my goals in life. *

Yes

Sometimes

I do not enjoy social gatherings because of my headaches. *

Yes

Sometimes

I get tense (e.g. muscle tension) because of my headaches. *

Yes

Sometimes

I find it difficult to read because of my headaches. *

Yes

Sometimes

I find it difficult to focus my attention away from my headaches and on other things. *

Yes

Sometimes

I avoid traveling because of my headaches. *

Yes

Sometimes

Section 2. For every 'yes' add 4 points, for every 'sometimes' add 2 points. Do not add any points for any 'no' responses.

Section 2 Total

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Captcha

Reference: Jacobson Gary P., Ramadan NM, et al., The Henry Ford Hospital Headache Disability Inventory (HDI). Neurology 1994; 44:837-842
FORM 502

Brain, Not Bone Alone

Get in Touch

Email

[email protected]

Address
25909 Pala Ste. 190

Mission Viejo, CA 92691

Phone Number

Call Office : 949-359-8385

Text Office: 949-619-6545

Hours of Operation

Monday - Wednesday

8:00am – 12:30pm & 2:30pm - 6:00pm

Thursday

8:00am – 11:15am & 2:30pm - 6:00pm

Friday

8:00am - 12:30pm

2 Saturdays/Month

9:00am - 12:30pm

25909 Pala Ste. 190

Mission Viejo, CA 92691

CLICK HERE TO PAY

Superbill Request

Insurance Verification

Terms & Conditions

Copyright 2025. All rights reserved.