1. Name or screen name (optional):
2. Email (optional):
3. Location (optional):
4. Age:
5. Sex:
6. Nationality and Race (optional):
7. Do you have classic migraine (migraine with aura) or common migraine (migraine without aura)? When did it begin?
8. What do you take for your classic or common migraine and does it help?
9. Have you been diagnosed with persistent aura (prolonged migraine aura status)?
10. What is your visual problem and how long does it last?
11. Any other problems that you think might be related?
12. What do you take or do for your vision problem and does it help?
13. Have you found a trigger for your vision problem?
14. What tests have you had and the results?
15. Drug history (pre VS)
16. Drug history (post VS - effect on VS - negative, positive, not at all)
17. Do you have a positive family history for migraine? If yes, who is affected?
18. Other information you want to provide?
2. Email (optional):
3. Location (optional):
4. Age:
5. Sex:
6. Nationality and Race (optional):
7. Do you have classic migraine (migraine with aura) or common migraine (migraine without aura)? When did it begin?
8. What do you take for your classic or common migraine and does it help?
9. Have you been diagnosed with persistent aura (prolonged migraine aura status)?
10. What is your visual problem and how long does it last?
11. Any other problems that you think might be related?
12. What do you take or do for your vision problem and does it help?
13. Have you found a trigger for your vision problem?
14. What tests have you had and the results?
15. Drug history (pre VS)
16. Drug history (post VS - effect on VS - negative, positive, not at all)
17. Do you have a positive family history for migraine? If yes, who is affected?
18. Other information you want to provide?
