Headache Disability Index
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Use our readymade template to create your Headache Disability Index (HDI) assessment tool

Create your care assessments

HDI score Disability Level Proposed treatment
0-9 No disability May not need treatment
10-29 Mild disability Consider counseling
30-49 Moderate disability Consider medication
50-71 Severe disability Active treatment
72-100 Complete disability Immediate initiation
  • navigate_next Prebuilt template with HDI scoring to assess the presence of headache disorders and measure their impact
  • navigate_next 25-item questionnaire that scores each item as “Yes” (4 points), “Sometimes” (2 points), or “No” (0 points)
  • navigate_next Real-time calculation of HDI Score and disability level based on the form responses
  • navigate_next Collect patient data and other sensitive healthcare data using our HIPAA compliant online assessment forms
  • navigate_next Compare the scores from the initial screening with that of the followup to track the progression of headache disorders
  • navigate_next Easily create responsive forms that allow patients to complete their assessments on any device at any time

Collect responses from your patients

Patient ID 1004
Patient Name John W
Patient Email johnw@ymail.com
Patient Phone Number 0987654321
Doctor's Name Dr. Smith
Location New York
I have a headache: more than once but less than four times per month
My headache is: moderate
Because of my headaches I feel disabled. Sometimes
Because of my headaches I feel restricted in performing my routine daily activities. Yes
No one understands the effect my headaches have on my life. No
I restrict my recreational activities (eg, sports, hobbies) because of my headaches. Yes
My headaches make me angry. Sometimes
Sometimes I feel that I am going to lose control because of my headaches. No
Because of my headaches I am less likely to socialize. Yes
My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. Sometimes
My headaches are so bad that I feel that I am going to go insane. No
My outlook on the world is affected by my headaches. Yes
I am afraid to go outside when I feel that a headaches is starting. Sometimes
I feel desperate because of my headaches. No
I am concerned that I am paying penalties at work or at home because of my headaches. Yes
My headaches place stress on my relationships with family or friends. Sometimes
I avoid being around people when I have a headache. No
I believe my headaches are making it difficult for me to achieve my goals in life. Yes
I am unable to think clearly because of my headaches. Sometimes
I get tense (e.g., muscle tension) because of my headaches. No
I do not enjoy social gatherings because of my headaches. Yes
I feel irritable because of my headaches. Sometimes
I avoid traveling because of my headaches. No
My headaches make me feel confused. Yes
My headaches make me feel frustrated. Sometimes
I find it difficult to read because of my headaches. No
I find it difficult to focus my attention away from my headaches and on other things. Yes
Emotional score 24
Functional score 20
HDI score 44
Disability Level mild disability
  • navigate_next Pre-populate patient details such as patient id, name, email etc in the HDI assessment form before sharing it with the patients
  • navigate_next Send an email invitation with a secure link for patients to complete their HDI assessment form prior to their visit
  • navigate_next Allow patients to save their progress and complete their HDI assessment form at a later time without losing any responses
  • navigate_next Set up an email template for your HDI assessment and automatically send invitation emails to multiple patients with ease
  • navigate_next Send a confirmation email to the patients with their HDI score, diagnosis, next steps when they submit their HDI assessment

Track patient responses in Google Sheets

A B C D E
1 Name Question Answer Score Total Score
2 John W Because of my headaches I feel disabled. Sometimes 2 44
3 John W Because of my headaches I feel restricted in performing my routine daily activities. Yes 4 44
4 John W No one understands the effect my headaches have on my life. No 0 44
5 John W I restrict my recreational activities (eg, sports, hobbies) because of my headaches. Yes 4 44
6 John W My headaches make me angry. Sometimes 2 44
7 John W Sometimes I feel that I am going to lose control because of my headaches. No 0 44
8 John W Because of my headaches I am less likely to socialize. Yes 4 44
9 John W My spouse (significant other), or family and friends have no idea what I am going through because of my headaches. Sometimes 2 44
10 John W My headaches are so bad that I feel that I am going to go insane. No 0 44
11 John W My outlook on the world is affected by my headaches. Yes 4 44
12 John W I am afraid to go outside when I feel that a headaches is starting. Sometimes 2 44
13 John W I feel desperate because of my headaches. No 0 44
14 John W I am concerned that I am paying penalties at work or at home because of my headaches. Yes 4 44
15 John W My headaches place stress on my relationships with family or friends. Sometimes 2 44
16 John W I avoid being around people when I have a headache. No 0 44
17 John W I believe my headaches are making it difficult for me to achieve my goals in life. Yes 4 44
18 John W I am unable to think clearly because of my headaches. Sometimes 2 44
19 John W I get tense (e.g., muscle tension) because of my headaches. No 0 44
20 John W I do not enjoy social gatherings because of my headaches. Yes 4 44
21 John W I feel irritable because of my headaches. Sometimes 2 44
22 John W I avoid traveling because of my headaches. No 0 44
23 John W My headaches make me feel confused. Yes 4 44
24 John W My headaches make me feel frustrated. Sometimes 2 44
25 John W I find it difficult to read because of my headaches. No 0 44
26 John W I find it difficult to focus my attention away from my headaches and on other things. Yes 4 44
  • navigate_next Export patient responses including the calculated HDI score and disability level to Google Sheets for easy record-keeping
  • navigate_next Export individual points for 25 items to Google Sheets for data manipulation and analysis for comprehensive insights
  • navigate_next Use pre-built reports to easily keep track of patient progress over time and monitor changes in their headache symptoms
  • navigate_next Receive a copy of the response and the calculated HDI score by email whenever a patient submits their HDI assessment
  • navigate_next Use data in Google Sheets to integrate with external EHR systems for seamless data transfer

HIPAA compliance

Patient ID: 1004
Patient Name: ******
Patient Email: ******
Patient Phone Number: ******
Doctor's Name: Dr. Smith
Location: New York
I have a headache: : more than once but less than four times per month
My headache is: : moderate
Because of my headaches I feel disabled.: Sometimes
Because of my headaches I feel restricted in performing my routine daily activities.: Yes
No one understands the effect my headaches have on my life.: No
I restrict my recreational activities (eg, sports, hobbies) because of my headaches.: Yes
My headaches make me angry.: Sometimes
Sometimes I feel that I am going to lose control because of my headaches.: No
Because of my headaches I am less likely to socialize.: Yes
My spouse (significant other), or family and friends have no idea what I am going through because of my headaches.: Sometimes
My headaches are so bad that I feel that I am going to go insane.: No
My outlook on the world is affected by my headaches.: Yes
I am afraid to go outside when I feel that a headaches is starting.: Sometimes
I feel desperate because of my headaches.: No
I am concerned that I am paying penalties at work or at home because of my headaches.: Yes
My headaches place stress on my relationships with family or friends.: Sometimes
I avoid being around people when I have a headache.: No
I believe my headaches are making it difficult for me to achieve my goals in life.: Yes
I am unable to think clearly because of my headaches.: Sometimes
I get tense (e.g., muscle tension) because of my headaches.: No
I do not enjoy social gatherings because of my headaches.: Yes
I feel irritable because of my headaches.: Sometimes
I avoid traveling because of my headaches.: No
My headaches make me feel confused.: Yes
My headaches make me feel frustrated.: Sometimes
I find it difficult to read because of my headaches.: No
I find it difficult to focus my attention away from my headaches and on other things.: Yes
Emotional score: 24
Functional score: 20
HDI score: 44
Disability Level: mild disability
HDI score: 44
Disability Level: mild disability
  • navigate_next Create a HIPAA compliant HDI assessment form to safely collect, store and access patient responses
  • navigate_next Mark fields as Protected Health Information (PHI) to secure sensitive patient data and limit access to PHI
  • navigate_next Automatically mask PHI fields when exporting HDI form responses to Google Sheets and sending them on email
  • navigate_next Prepopulate patient details in HDI assessments by creating secure prefill links without exposing PHI
  • navigate_next Limit access to patient data only for authorized personnel and minimize the risk of data breaches

These reviews are reproduced without modification from Google Workspace Marketplace.

July 27, 2023

5 stars

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July 23, 2023

5 stars

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— Sol Evans

February 16, 2024

1 stars

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— Myles Sicuro

October 31, 2023

5 stars

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July 12, 2023

5 stars

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November 27, 2023

5 stars

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July 10, 2023

5 stars

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