Research

Nutrasweet/aspartame and Possible Connections to Head Aches

 

Name - ___________________________
Date - ____________________________
 
Pre-survey - Part I (Please circle your response.)
1. I have severe/migraine headaches
1. never
2. very seldom
3. seldom
4. often
5. frequently
 
2. I consume diet drinks containing Nutrasweet/aspartame.
1. never
2. very seldom
3. seldom
4. often
5. frequently
 
3. I consume sugar-free food products containing Nutrasweet/aspartame.
1. never
2. very seldom
3. seldom
4. often
5. frequently
 
Pre-survey - Part II
1. Some of the products I consume containing Nutrasweet/aspartame on a regular basis are:
_____________________
_____________________
_____________________
_____________________
_____________________
_____________________
 
2. I have consumed Nutrasweet/aspartame products
a. never
b. 1-5 years
c. 5-10 years
d. 11 + years
 
3. I have long term health conditions that may affect incidences of headaches. These are:
_____________________
_____________________
_____________________
_____________________
_____________________
 
4. I consume 8-10 glasses of water per day. (please circle the correct response)
yes
no

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