Appendix CData Collection Form

Publication Details

Data Abstraction Form

ver 5.19.95

Reviewer ______

First Author (last name): _________

Pro-Cite no.: ______

Todays date:___/___/___


Are most or all of the patients in this study in the pediatric age group (0–17)? No Yes -> STOP

State the inclusion criteria (headache diagnoses first)

Headache diagnosis: Migraine Tension-type Cluster mixed


Diagnostic criteria: IHS Ad hoc other none/NS

State the exclusion criteria (headache diagnoses first)

Patient enrollment site (circle all that apply)

Primary Care Clinic General Neurology Clinic Headache Clinic Not Stated

Emergency Clinic Pain Clinic Psychology clinic Other ____________



Single-period parallel-group


Matched pair (or paired)

For Cross-over design only-> Was there a significant carry-over effect? Yes No Not Stated

If "yes" then abstract "period one" data only as if the trial used a parallel group design.

Patient characteristics (overall: if figures are given by treatment groups, then calculate weighted average)

Age ___±___ or ____ (___ to ___)

mean ± std dev median and (lower to upper) range

Female (%) ____

Chronicity of H/A d/o (x̄, years) ____

HA frequency (#HA/mo)

Patient characteristics describe: pre-treatment (trial entry) post-treatment (completion)