Survey Form – Migrainepolice

The aim of this test is to investigate whether a major group could avoid/reduce their problems that very often are triggered by the consumption of red wine by following the recommendations of MigrainePolice.com

This is NOT science, but a practical test to be used as a basis for recommendations to increase knowledge and to generate a database of experiences that can be used to benefit migraine- and headache sufferers.

The information we collect will be used for data analysis only. Only questions with a red asterisk "*" are mandatory.

We look forward to receiving your submission, which we will include in the total research for future analyzes.

Name and Gender

Your preferred email - we will only use this email for purposes of this study and updates. You can choose to opt of any future emails at the end of this form

Email

Your Name

Headache

'Describe in average days per week how frequent you suffer from migraine headaches (regardless of severity)'

Headache Frequency per week
Describe in average days per week how frequent you suffer from migraine headaches (regardless of severity)

Headache Frequency per week

Not often or rarely1-2 days3-4 days5-7 days

Which wine?

Headache sufferers around the world have their own experiences on which wine they prefer. What wine, that you have experienced that are better for you than most others, do YOU prefer?
Please describe name, brand, vintage, country, district and type of grapes

Why do YOU imagine this wine is different from most others?

Amount

How much wine did you drink for the purposes of this survey. It is important that you avoid all other alcoholic drinks the day you drink this wine.

Amount you drank

Less than a glass of whineAbout a glass of wine2-3 glasses of wine or 1/2 bottleMore than 1/2 bottle

Taste and Familiarity

'On a scale of 1 - 6 (where 1 is "very bad" and 6 is "Excellent") how would you rate the taste of this wine?'

'Are you familiar with this wine type (Barbera or Dolcetto D'Alba)?'

YesNo

Comments and Medication

'Please provide any other reactions or comments about this wine that may not have been answered from the questionnaire.'

Comments

'Please describe if and what medication(s) you take for headache or migraine attack/Profylactic (on a regular basis)/Profylactic when drinking wine?'

Medication

Email Opt Out

'Select this option if you wish to opt out of updates, results of this test, and any future studies.'

Remove me from your list - Thank you