COMMON INDICATORS OF A HEAD INJURY

This questionnaire is not meant to be a formal "test" to see if you have a head injury. If you have multiple "YES" answers, bring this questionnaire to your doctor. Additional tests (medical and neuropsychological) maybe ordered.

HEADACHES

Yes	No	Do you have more headaches since the injury or accident?
Yes	No	Do you have pain in the temples or forehead?
Yes	No	Do you have pain in the back of the head (sometimes the pain will start at the back of the head and extend to the front of the head)?
Yes	No	Do you have episodes of very sharp pain (like being stabbed) in the head which lasts from several seconds to several minutes?

MEMORY

Yes	No	Does your memory seem worse following the accident or injury?
Yes	No	Do you seem to forget what people have told you 15 to 30 minutes ago?
Yes	No	Do family members or friends say that you have asked the same question over and over?
Yes	No	Do you have difficulty remembering what you have just read?

WORD-FINDING

Yes

Do you have difficulty coming up with the right word (you know the word that you want to say but can’t seem to "spit it out")?

FATIGUE

Yes	No	Do you get tired more easily (mentally and/or physically)?
Yes	No	Does the fatigue get worse the more you think or in very emotional situations?

CHANGES IN EMOTION

Yes	No	Are you more easily irritated or angered (seems to come on quickly)?
Yes	No	Since the injury, do you cry or become depressed more easily?

CHANGES IN SLEEP

Yes	No	Do you keep waking up throughout the night and early morning?
Yes	No	Do you wake up early in the morning (4 or 5 a.m.) and can’t get back to sleep?

ENVIRONMENTAL OVERLOAD

Yes

Do you find yourself easily overwhelmed in noisy or crowded places (feeling overwhelmed in a busy store or around noisy children)?

IMPULSIVENESS

Yes

Do you find yourself making poor or impulsive decisions (saying things "without thinking" that may hurt others feelings; increase in impulse buying?)

CONCENTRATION

Yes

Do you have difficulty concentrating (can’t seem to stay focused on what you are doing)?

DISTRACTION

Yes

Are you easily distracted (someone interrupts you while you are doing a task and you lose your place)?

ORGANIZATION

Yes

Do you have difficulty getting organized or completing a task (leave out a step in a recipe or started multiple projects but don’t complete them)?

__________ Total Number of Yes Answers

If you have 5 or more Yes answers,
discuss the results of this questionnaire with your doctor.

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Related Links || Download the Book

CONTENTS
Common Indicators of a Head Injury || How the Brain is Hurt
Understanding How the Brain Works

COPING WITH COMMON PROBLEMS
Memory || Headaches || Problems Getting Organized || Getting Overloaded
Sleep Disorders || Fatigue || Anger and Depression || Word-finding

Dealing with Doctors || Family Members: What You Can Do In the Hospital Setting

Seizures || Emotional Stages of Recovery || Returning to School
When Will I Get Better? || Who Are All These Professionals?

TRAUMATIC BRAIN INJURY SURVIVAL GUIDE
By Dr. Glen Johnson, Clinical Neuropsychologist

5123 North Royal Drive || Traverse City, MI 49684
Phone: 231-929-7358 || Email: debglen@yahoo.com
Website http://www.tbiguide.com/