The Headache Healer’s Handbook. Jan Mundo

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       Dose unit (tablet/tsp/mg/ml): ______ Frequency (per day/week/month): ______

       Dates taken: ____ to ____ # of years taken: ____

       Still use? yes no

       Effective? yes no

       Side effects? yes no

       List side effects: ______________________________________________________

       Reason(s) stopped or still using: ________________________________________

       MEDICATION: __________________________________________________

       Dose unit (tablet/tsp/mg/ml): ______ Frequency (per day/week/month): ______

       Dates taken: ____ to ____ # of years taken: ____

       Still use? yes no

       Effective? yes no

       Side effects? yes no

       List side effects: ______________________________________________________

       Reason(s) stopped or still using: ________________________________________

       MEDICATION: __________________________________________________

       Dose unit (tablet/tsp/mg/ml): ______ Frequency (per day/week/month): ______

       Dates taken: ____ to ____ # of years taken: ____

       Still use? yes no

       Effective? yes no

       Side effects? yes no

       List side effects: ______________________________________________________

       Reason(s) stopped or still using: ________________________________________

      29. Circle any other therapies you have tried for your headaches:

Therapy	Currently using?	Effective?
	Yes	No	Yes	No	Not sure
Acupuncture
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