|
| Increased tension | Don’t know | Never | Seldom | Sometimes | Often | Almost always |
|
| Overwork (e.g., prolonged working hours, long periods of studying/typing) | □ | □ | □ | □ | □ | □ |
| When tired | □ | □ | □ | □ | □ | □ |
| Mental strain (e.g., overthinking or other concentration) | □ | □ | □ | □ | □ | □ |
| Eyestrain (e.g., reading, computer, or TV) | □ | □ | □ | □ | □ | □ |
| Muscular strain (muscle tightness) | □ | □ | □ | □ | □ | □ |
| Physical labour | □ | □ | □ | □ | □ | □ |
| Lack of sleep | □ | □ | □ | □ | □ | □ |
| Poor posture in sitting, standing or sleeping | □ | □ | □ | □ | □ | □ |
|
| Diet |
| Alcohol | □ | □ | □ | □ | □ | □ |
| Coffee | □ | □ | □ | □ | □ | □ |
| Dehydration | □ | □ | □ | □ | □ | □ |
| Hunger/being hungry | □ | □ | □ | □ | □ | □ |
| Chocolate | □ | □ | □ | □ | □ | □ |
| Cigarette smoking | □ | □ | □ | □ | □ | □ |
| Soft drink/sodas | □ | □ | □ | □ | □ | □ |
| Tea | □ | □ | □ | □ | □ | □ |
| Cheese | □ | □ | □ | □ | □ | □ |
| Dairy foods (e.g., milk, ice cream, etc.) | □ | □ | □ | □ | □ | □ |
| Monosodium glutamate (MSG) | □ | □ | □ | □ | □ | □ |
| Sugar/too much sugar | □ | □ | □ | □ | □ | □ |
| Spicy food | □ | □ | □ | □ | □ | □ |
| Overconsumption of oily food | □ | □ | □ | □ | □ | □ |
| Irregular diet (e.g., eating on the run, skip meals) | □ | □ | □ | □ | □ | □ |
|
| Weather |
| Change of weather | □ | □ | □ | □ | □ | □ |
| Change in temperature | □ | □ | □ | □ | □ | □ |
| Exposure to bright lights or sunshine | □ | □ | □ | □ | □ | □ |
| Hot weather | □ | □ | □ | □ | □ | □ |
| Cold weather | □ | □ | □ | □ | □ | □ |
| Windy days | □ | □ | □ | □ | □ | □ |
| Damp weather/humid weather | □ | □ | □ | □ | □ | □ |
| Rainy days | □ | □ | □ | □ | □ | □ |
|
| Stress and emotional changes |
| Stress | □ | □ | □ | □ | □ | □ |
| Nervousness | □ | □ | □ | □ | □ | □ |
| Anger or irritability | □ | □ | □ | □ | □ | □ |
| Anxiety (excessive worry) | □ | □ | □ | □ | □ | □ |
| Depression (feeling unhappy or depressed) | □ | □ | □ | □ | □ | □ |
| Tension or conflict-related (e.g., from financial constraints, family, relationship, and/or work) | □ | □ | □ | □ | □ | □ |
|
| Other factors |
| Sneezing | □ | □ | □ | □ | □ | □ |
| Teeth grinding | □ | □ | □ | □ | □ | □ |
| Other (please specify) |
|
