Qeustionaire from "Coping With Lyme Diease" page 25-28.

I won't bother to type out all the questions.
Rather, here are the 50+ of 66 applicable questions that I answered YES to:


The Bite:
1) tick bite
2) rashes on other parts of body

Head, Face, Neck:
3) headache, mild or severe
4) twitching of facial or other muscles
5) tingling or nose, cheek or face
6) stiff or painful neck, creaks and cracks
7) jaw pain or stiffness
8) sore throat

Eyes/Vision:
9) double or blurry vision
10) increased floating spots
11) pain in eyes, or swelling around eyes
12) oversensitivity to light
13) flashing lights

Ears/Hearing:
14) Pain in ears, oversensitivity to sounds
15) Ringing in one or both ears

Digestive and Excretory System:
16) Diarrhea
17) Constipation
18) Irritable bladder (trouble starting, stopping)
19) upset stomach (nausea or pain)

Musculoskeletal system:
20) joint pain or swelling
21) stiffness of joints, back, neck
22) muscle pain or cramps

Respiratory and Circulatory:
23) shortness of breath, cough
24) chest pain or rib soreness
25) night sweats or unexplained chills
26) hart palpitations or extra beats

Neurologic:
27) tremors or unexplained shaking
28) burning or stabbing sensations in the body
29) weakness or partial paralysis
30) pressure in head
31) numbness in body, tingling pinpricks
32) poor balance, dizziness, difficulty walking
33) increased motion sickness
34) lightheadedness, wooziness

Psychological Well-being:
35) mood swings, irritability
36) unusual depression
37) disorientation (getting or feeling lost)
38) feeling as if you are losing your mind
39) overemotional reactions, crying easily
40) too much sleep, or insomnia
41) difficulty falling or staying asleep

Mental Capacity:
42) memory loss (short or long term)
43) confusion, difficulty in thinking
44) difficulty with concentration or reading
45) going to the wrong place
46) speech difficulty, (slurred or slow)
47) unexplained menstrual pain, irregularity (I do know I have endomitriosis)

General Well-being:
48) extreme fatigue
49) swollen glands
50) unexplained fevers (high- or low-grade)
51) continual infections (sinus, kidney, eye, etc.)
52) symptoms seem to change, come and go
53) pain migrates to different body parts
54) early on, experienced a "flu-like" illness, after which you have not felt well