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ALLODYNIA QUESTIONNAIRE BAYLOR UNIVERSITY MEDICAL CENTER DALLAS, TEXAS ALLODYNIA QUESTIONNAIRE 52670 (08/10) Do you experience pain or any unpleasant sensation on your skin during a migraine attack when you engage in ANY of the following activities? Please circle your answer. Combing your hair Yes No N/A Pulling your hair back (example: ponytail) Yes No N/A Shaving your face Yes No N/A Wearing eyeglasses Yes No N/A Wearing contact lenses Yes No N/A Wearing earrings Yes No N/A Wearing necklaces Yes No N/A Wearing tight clothes Yes No N/A Taking a shower Yes No N/A (when shower water hits your face) Resting your face on the pillow on the Yes No N/A side of the headache Being exposed to heat Yes No N/A (examples: cooking, placing heating pads on your face) Being exposed to cold Yes No N/A (examples: breathing through your nose on a cold day; placing ice packs on your face)

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ALLODYNIA QUESTIONNAIRE

BAYLOR UNIVERSITY MEDICAL CENTERDALLAS, TEXAS

ALLODYNIA QUESTIONNAIRE

52670 (08/10)

Do you experience pain or any unpleasant sensation on your skin during a migraine attack when you engage in ANY of the following activities?

Please circle your answer.

Combing your hair Yes No N/A

Pulling your hair back (example: ponytail) Yes No N/A

Shaving your face Yes No N/A

Wearing eyeglasses Yes No N/A

Wearing contact lenses Yes No N/A

Wearing earrings Yes No N/A

Wearing necklaces Yes No N/A

Wearing tight clothes Yes No N/A

Taking a shower Yes No N/A(when shower water hits your face)

Resting your face on the pillow on the Yes No N/Aside of the headache

Being exposed to heat Yes No N/A(examples: cooking, placing heating padson your face)

Being exposed to cold Yes No N/A(examples: breathing through your noseon a cold day; placing ice packs on your face)