What is your most common headache trigger? You can choose more than one answer for any question. *

Emotional stress or disrupted sleep

Certain foods like wine, MSG, or histamine-rich items

Hot weather, altitude, or hormonal changes

Skipping meals or intense physical activity

Which of these other health issues have you dealt with? (check all that apply)

Chronic fatigue, fibromyalgia, or post-viral crashes

Raynaud’s, high blood pressure, POTS

IBS, joint pain, or seasonal allergies

Anxiety, depression, or insomnia

What best describes your pain? *

Pressure, sinus-like, or pain triggered by food or gut issues

Tight, tension-like with neck pain

Fatigue-related, often after travel, fasting, or physical effort

Throbbing, one-sided, often with visual aura (flashing shapes in vision before head pain)

Have any of these supplements helped you? (Skip this one if you have not tried supplements)

Magnesium

Adaptogens like ashwagandha

Probiotics or fish oil

CoQ10 or riboflavin (Vitamin B2)

What happens when you’re in a high-stress situation? *

I get stomach symptoms or skin rashes

I feel completely drained, like I’m running on empty

I get overwhelmed or emotionally reactive

My blood pressure spikes

What describes your energy pattern on most days? *

Pretty good unless hormones shift

Low energy all the time, and sleep doesn't seem to help

Good in the first half of the day, and then I crash

Varies, worse if my sinuses or allergies are flaring up

Which medications help you? (check all that apply) *

Anti-inflammatories like Ibuprofen or Naproxen

Amitriptyline or Nortriptyline as a daily preventive

Nurtec, Ubrelvy, Imitrex, or Maxalt

Topiramate as a daily preventive

How does exercise affect you? *

Completely drained or headachy for hours or days

Emotionally uplifted

Exercise often triggers headaches or migraines

Sore, inflamed, or achy joints

Do you have any of these sleep issues? *

I have a stuffy nose and breathe through my mouth

I have trouble falling asleep or staying asleep

I sleep long but wake unrefreshed and foggy

No sleep problems

Do you have any of these with your headaches or migraines? *

Mood changes

Nausea or vomiting / bloating

Pounding and/or high blood pressure

Extreme fatigue, I usually need to sleep

First Name *

Email *

You’ll see your Headache Type on the next page, and I’ll email you a copy of my latest eBook for free as well: "Unlock the Code to Lasting Pain Relief"