Exploding Head Syndrome (EHS) Survey

Have you participated in this survey before?

• Yes
• No

When does your EHS episodes occur?

Please select all that apply.

• While awake
• While asleep
• While falling asleep
• While waking up

What do you experience during a episode?

Please select all that apply.

• Visual stimulation
• Auditory stimulation
• Movement or Vibration
• Sound not detected with Auditory functions. (example: sense of buzzing in head that doesn't present as an outside noise)

Are these episodes painful?

• Yes
• No
• Sometimes

How intense are the episodes?

• Extreme
• Mild
• Sometimes extreme, but mostly mild
• Sometimes mild, but mostly extreme
• Neither

How old are you?

• 15-25
• 26-40
• 41-60
• 60+

What is your gender are you biologically?

• Male
• Female

Do these episodes produce fear?

• Yes
• No
• Sometimes

What position are you in while this occurs?

• Upright
• Sitting down
• Laying on back
• Laying on stomach
• Laying on side
• Other

What sleep pattern best describes yours?

• Regular (6-8 hours once every 24 hours) uninterrupted
• Regular (6-8 hours once every 24 hours) interrupted
• Irregular

Do you suffer from insomnia?

• Yes
• No
• Sometimes

Do you use sleeping aids?

• Yes
• No
• Sometimes

Can you move while in having and EHS episode?

• Yes
• No
• Sometimes

While having an EHS episode, can you prevent it from forming?

• Yes
• No
• Sometimes

Does the episode present with any accompanying traits?

Please select all that apply.

• "Shadowy figures" or any other malicious images.
• Benign images
• Feeling as if awake, but still dreaming
• Other

How would you describe your general health?

Please select all that apply.

• Seriously Healthy: active, no serious medical conditions, not taking drugs and observes good eating habits
• Lax: pretty healthy, but no serious focus on exercise, and diet
• Minor Medical Conditions: Would be considered pretty healthy except for some minor medical ailments
• Serious Medical Conditions: Managing medical conditions, that are pretty detrimental to health
• Not Healthy-introduces harmful substances to body and/or neglects diet and exercise

What would you consider your general stress level to be?

• Extreme
• High
• Mild
• Low
• Non-existent

How is your general nervous state?

• High-strung, lots of anxiety, mind always on "Go".
• Excitable, easily triggered into high-strung status.
• Regular, in control over nerves, can turn mind "off" for a break.
• Chill, no worries, almost impossible to get "worked-up"

Do you consume caffeine?

• Yes
• No
• Sometimes

Do you have an existing mental disorder?

• Yes
• No
• None that I'm aware of