Skip survey header

CHAMP Headache Disease Patient Access Survey

Consent

Purpose

You are invited to participate in an important survey being conducted by the Coalition For Headache And Migraine Patients (CHAMP) and its partner organizations. CHAMP is conducting this survey to better understand the experiences people with headache diseases have had with their health care providers, treatments, and insurance providers. Your responses will help advance research and improve access to appropriate care and therapies for migraine and other headache diseases as we focus on conversations with health care professionals, insurers, state and federal lawmakers, and other agencies that fund and conduct research.

You will be able to view any reports we produce from these data on our website (www.headachemigraine.org). If you would like to receive a copy of any reports we make from these survey data, please email us at: survey@headachemigraine.org.  

Participation & Time Commitment

This survey is open to people in the United States or U.S. territories, who are 18 years old or older, and have experienced at least one headache in the past year not due to hangover or illness (such as cold or flu).

Completing this survey is expected to take 15-20 minutes. If you need to return to a previous page or page ahead, please use the survey navigation buttons at the bottom of your screen. Do not use your browser forward or back buttons.

If you are someone with headache or migraine, we recognize you may not feel well. If you need to pause your progress at any time, there is an option to save the survey and continue later. A link will appear at the top of the following pages. Click this Save & Continue link (or icon) and enter your email address. You will be sent an anonymous link so you can complete your survey later. **If you close your browser before completing these steps, you will not be able to access the survey link again.** You may also stop the survey at any time.

Thank You Drawing Entry & Eligibility
  • Everyone is eligible for entry in a drawing for one of twenty $25 Amazon gift cards. If you do not consent to take the survey or do not meet eligibility criteria, you will be sent to an entry form where you can provide your email address for one [1] entry in the drawing.
  • A partially completed survey is eligible for two [2] entries in the drawing. Instructions for entry are included in the email sent with the link to complete your survey later.
  • Those who complete the survey earn a total of five [5] entries. If you save and return to the survey later or complete it in one sitting, instructions for entry are provided upon completion.

Your odds of winning depend on the number of entries we receive. The drawing for prizes will take place on or about January 15, 2020.

Data Confidentiality

This survey is intended to be anonymous. Please do not share any personally identifying information (e.g., your name, email, or phone number in this survey). Your survey responses will be maintained on the password-protected computers of CHAMP research staff and partners. Any reports using these data will be made in aggregate, and used for research and advocacy purposes only. Your separate contact information will be maintained by CHAMP only if you express interest in joining our mailing list (optional).

Study Contacts

If you have any questions or would like to withdraw from the survey, please contact:

Beth Morton
Principal Investigator
Coalition For Headache And Migraine Patients
survey@headachemigraine.org  

If you have questions about your rights or any survey-related harms:

BRANY
1981 Marcus Avenue, Suite 210
Lake Success, NY 11042
P. 516-470-6900
F. 516-470-6903
info@brany.com
 
1. Do you consent to participate in this survey? *This question is required.