Dose the patient being treated have any of the following conditions?

• Less than 8 years old.

• Fever over 103 F.

• Symptoms that have gotten worse or new symptoms have developed after trying an OTC treatment.

• Asthma, COPD, or other respiratory conditions.

• Conditions that effect the heart and lungs such as congestive heart failure.

• Chest pain or shortness of breath.

• Immunosuppression from a health condition or from medications such as hydrocortisone, budesonide, methylprednisolone or other steroids, cyclosporine, methotrexate, azathioprine or other medications.

• AIDS.

• Elderly and frail .

• Allergic or hypersensitive to over the counter medications.

• Severe head pain.

• Headache that has persisted for more then 10 days.

• Pregnancy.

• Using analgesics (tylenol, ibuprofen, naproxen) more than 3 days per week for headache.

• Having any of the following symptoms, and have never been diagnosed with a migraine: Nausea, headache on only one side of the head, visual changes such as seeing lines or changes in light before the onset of the headache, numbness or tingling before the onset of the headache, trouble speaking before the onset of the headache, worsened mood after the headache, depression after the headache, fatigue after the headache, and difficulty solving problems after the headache.


Yes

No



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