Tuliv Migraine Profile

Better understanding of your migraines and why you get them is your first step to migraine prevention. Your profile will be confidentially reviewed by one of our professional migraine specialists and you will receive a personal response via email which is  directly related to the information you provide. 

Your information is confidential and is never exposed or shared. Please take the time to answer all questions that pertain to you.

* Required

First and Last Name*

Email Address To Receive Response*

Gender * Male Female

Current Age *

Current Weight *

Who else in your family gets migraines? * Mother Father Sibling Children Grandparent Other Relatives (aunts uncles cousins) Don't know of other family members who get migraines Don't know natural family history

At what age did migraines start? *

How many days per month do you get headaches? Less than 1 1-3 4-7 7-15 15 or more Almost every day Always - never seems to go away

What statement best describes your activity level when you have migraines? I can continue with my normal activity most of the time. My normal activities are impaired and I am not productive. I must stop what I am doing and rest for a while. I am totally incapacitated and must go to bed

Where is your headache pain located? Side of Head Forehead Sinus area Top of head Back of head above neck Facial area or jaw line Entire head Behind the eyes

Describe your headache pain in your own words

What seems to be the pattern of your headaches? I sometimes wake up around 4 AM with a headache Start after I get up in the morning Headache is full blown by 10 AM Headaches generally start in the afternoon Headaches come after 5 PM Get headaches after exercising Affected by smells and sound and sight Weather changes cause headaches Some foods trigger my headaches I know of other triggers Women: my period triggers headaches No real pattern - headaches come any time I've never really thought about when the come or go

How has the pattern, frequency or severity of your migraines changed within the past 3 years.

Do you get aura or vision disturbances before or with your migraine? Yes No Sometimes

What other types of pain do you have in relation to your migraines? Neck pain Sinus pain or sinus type headache Pain in the eyes Facial pain Fibromyalgia Jaw or dental pain Back or shoulder pain Menstrual pain Stomach Nausea Other

What types of medication do you currently take for pain or to stop headaches. Triptan drugs such as Imitrex Maxalt Frova Relpax Prescription pain medications Over the counter medications such as Advil or Tylenol or Aspirin Herbal or natural medications Nothing - just wait for them to pass Other

What are you currently taking or have tried for migraine prevention? Topamax Depakote or other anti-seizure medications Botox Natural formula or herbal medications for migraines Feverfew or butterbur Anti-depression drugs Other prescription drugs Not using anything Other

Please list names of prescription drugs you have tried for migraine prevention.

Please list the names of natural products or herbal medications you have tried for migraine prevention.

Please check any of the following that you are currently taking: Herbal or natural dietary supplements Probiotic - Supplements or other form Acidophilus - in any form including yogurt Multi-Vitamin & Mineral Resveratrol Energy drinks Health drinks Digestive aids Cholesterol drugs Viagra or Celebrex Other - that may be triggering migraine (list below)

Please provide the brand names of anything you checked above and we will review each to see if it contains anything that may be contributing to your migraine problem and report back to you.

Since many types of prescription drugs can influence migraine occurrences, please list the names of other pharmaceuticals you are currently taking.

What types of service are you currently using for your migraines? Doctor - general practitioner or family doctor Neurologist Acupuncturist Naturalist Chiropractor Gynecologist (OB/GYN) Other Doctors (such as endocrinologist or psychologist) Self Help - researching on my own Other

WOMEN ONLY

Whether or not you are still having periods, what have (or did) you noticed about your migraine in relations to your menstrual cycle? Headaches occur a few days before my period starts Headaches occur during my period Sometimes I get headaches the day after my period stops Headaches sometime happen during ovulation (10-14 days after period) Never noticed any relationship to menstrual cycle

Are you currently taking or using a hormone based for of birth control, including pills, shots, rings, etc.? Yes No Stopped taking within the past 3 months

If the answer above was Yes, please list name of the products you are using.

Are you currently taking or using some form of HRT (Hormone Replacement Therapy) including creams, shots, pills, supplements, etc.? Yes No Stopped within the past 3 months

If answer to above was Yes, please list name of all products you are using or taking.

Are you still having menstrual periods? Yes No Occasionally

Have you noticed any premenopausal or menopausal symptoms such as hot flashes or other changes? Yes No Occasionally

Please ask any questions you may have about migraines and your condition.

Personal Help For You

We know migraines. Call 1-866-367-5953 (outside the US and Canada call 405-692-4395) or contact us online to visit with us. You are directly connected to a migraine specialist, without sales pressure or automated operators. All calls are considered personal and confidential. There is no cost or obligation for your call.