Appendix 1 - Patient Preference Form (8/4/2004 Version 2)

Appendix 1 - Patient Preference Form (8/4/2004 version 2)

You have tested two different medicines for the treatment of migraine crises in the last months. We would like to know if you have a preference for one of both medicines, and why.

Instructions:

This form consists of 4 pages. What you have to do is explained on the first 2 pages. Please read these pages carefully before filling in the form on page 3.

You see below a line with numbers.

EXAMPLE:

You can indicate your preference (on page 3) by drawing a cross on the line. If you have no preference, please draw a cross in the middle of the line. If you have a preference for the medicine of the first period, please draw a cross on the left to the middle. If you have a preference for the medicine of the last period, please draw a cross on the right to the middle.

Also indicate how strong your preference is. If you have a strong preference for the medicine of the second period, draw the cross quite on the right. On the other hand, if you have a mild preference for the medicine, then draw the cross closer to the middle. The farer from the middle, the stronger your preference.

You will find 3 examples on the following page.

People may have a preference for a given medicine for various reasons. We would like you tell us why you have a preference or no preference. You can mention your reasons in this form.

Good luck.

3 EXAMPLES

Example # 1: this person has no preference for one of both medicines.

Example # 2: this person has a mild preference for

the medicine of the first period.

III

Example # 3: this person has a strong preference for

the medicine of the second period.

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Patient Preference Form

Which medicine do you prefer?

The medicine from the first period or the medicine from the second period?

Draw a cross on the line.

If you have a preference for one of both periods, then describe why below.

You can give several reasons.

If you have no preference, then indicate why not.

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Patient Preference Form

You will find below a series of properties of medicines. Tick which of the properties below had an influence on determining your preference.

Rapid activity;

in the preference period, headaches abated soon after medication intake.

Prevention of aggravation;

in the preference period, I could prevent aggravation of the headache crisis with the medication.

Reduction of severity;

in the preference period, the medication ensured that headache crises were less severe.

Complete analgesia;

in the preference period, headaches totally disappeared after medication intake.

Protracted activity;

in the preference period, headache did not return within 1-2 days after medication intake.

Reduction of nausea;

in the preference period, nausea decreased soon after medication intake.

Reduction of hypersensitivity;

in the preference period, light and noise hypersensitivity decreased soon after medication intake.

Recovery of functioning;

in the preference period, I could rapidly resume my normal activities soon after medication intake.

No side effects;

in the preference period, the medication induced little or no side effects.

Reliable activity;

in the preference period, the medication worked just as well on each crisis.

Single dose;

in the preference period, one single dose was enough to treat a crisis.

The taste;

in the preference period, the taste of the medication was pleasant.

No one of the properties mentioned above had an influence.

Others, namely: ______

Which property was the most influential? ______

You have finished. Many thanks for having filled in the form.