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Sleep and Headache Survey
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*
1.
age
*
2.
gender
female
male
*
3.
grade(e.g.2025级)
*
4.
average day the sleep duration
*
5.
average day the sleep duration
xx hours
<6h
6-7h
>7h
*
6.
how would you rate your sleep quality
very good
good
fair
poor
very poor
*
7.
headache frequency (past 3 months)
<1 per month
1-3 per month
1-3 per week
more than 4 per week
*
8.
headache severity
not severe (1)
very severe (10)
*
9.
does lack of sleep trigger your headache
yes
no
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10.
caffeine intake(coffee/tea/energy drink)
none
3 or less than 3 times per week
4 or more than 4 times per week
*
11.
physical activity per week
none
1-2times
3 or more
*
12.
time spent on screens per day
less than 2h
2-4h
4-6h
more than 6h
*
13.
stress level
unstressed (0)
stressful (10)
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Sleep and Headache Survey
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