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National Migraine Registry

Registry registration

This is a PHS registry and research pathway, not a clinic visit and not a diagnosis tool. Learn more about the registry

Individual records, phone numbers, email addresses and health details are never published. Public pages show anonymized totals only. Please read the Privacy Policy before submitting.

Enrolment form

Personal Information

Used only for private registry administration. Never published on this website. National ID / CNIC is not collected.

Used only for private registry follow-up. Never published on this website.

Gender

Provide date of birth, or age below if you prefer not to give a full date.

Optional if date of birth is provided. Enter age in years.

Contact Information

PHS reviewers may use these details for follow-up. They are never listed publicly.

Pakistan mobile number, for example 03XXXXXXXXX or +92 3XXXXXXXXX.

Required for follow-up. Never published on the website.

Preferred Contact Method

Migraine Information

Optional migraine history for the registry. This is not a diagnosis and not a clinic visit.

Diagnosed with migraine by a doctor?

How long have you been experiencing migraine?

How often do you have migraine or headache?

Do attacks affect daily activities?

Have you received treatment for migraine?

Optional. Do not include information you do not wish PHS to store.

Optional. Anything else you would like PHS reviewers to know.

Healthcare

Optional. Share only what you are comfortable storing with PHS reviewers.

Currently under the care of a doctor for migraine?

Consent & Privacy

This form is a registry and research pathway. It is not a clinic visit, not a diagnosis, and not a request for treatment. Individual records stay private. Please read the Privacy Policy.

Pakistan Headache Society National Migraine Registry — participant consent (v1) By submitting this form you agree to participate in the Pakistan Headache Society (PHS) National Migraine Registry. The information you provide may be used by PHS for the registry and for research, in accordance with the website Privacy Policy. You confirm that the information you give is accurate to the best of your knowledge. This is a registry and research pathway. It is not a clinic visit, not a diagnosis, and not a request for medical treatment. Privacy notice: Individual records, phone numbers, email addresses and health details are never published on this website. Public pages show anonymized aggregate counts only. Please read the Privacy Policy before you submit.
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