Add you clinic to our Headache Clinic Locator Database.Home » Find a Specialist » Headache Clinics in Canada Questionnaire "*" indicates required fieldsStep 1 of 250% Thank you for your interest in having your clinic added to our Headache Clinic list.Please complete the intake form below. By submitting your clinic information, you consent to having it posted on our clinic locator.Clinic Contact InformationContact Name*Please provide the full name of the main point of contact for this clinic. First Last Contact Email*Your contact email is for internal communication only and will not be posted online.Your email will be added to our Migraine Minute monthly bulletin that includes information on new resources and programs Migraine Canada has available. We hope you will share our resources with your patients.What is the name of the clinic?*Clinic Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Clinic Phone number*ExtensionClinic Email*if available Clinic Website*Clinic Fax numberClinic InformationChoose what describes the Clinic best.* Outpatient clinic, public Outpatient clinic, private (out of pocket payments) Academic, part of a University Department Hospital-based (non-university) OtherHow many physicians are part of the Headache Clinic?* 1 (solo practice) 2-3 4 +Provide the names of health care providers involved in headache care at your clinic.Are the clinic staff registered with the Canadian Headache Society?* Yes NoAre members of your clinic actively participating in Continuing Medical Education (CME) related to headache medicine?* Yes No UnsureWhich of the following work in your clinic?*Check all that apply Registered nurse Nurse practitioner Neurologist Physiatrist Internist Family physician Ophthalmologist ENT specialist Dentist Temporomandibular Disorder (TMD) Specialist Mental Health Professional OtherPlease specifyWhich age groups do you provide care for?Adults* Yes NoTeens (12-18)* Yes NoChildren* Yes NoDo you accept referrals for the following conditions?*Check all that apply. Migraine Cluster headache Facial pain / trigeminal neuralgia Acute / new onset headaches <1 month Post-traumatic headache, acute (concussion, mTBI) Post-traumatic headache, chronic Patients on long acting opioids for another pain OtherOther ConditionWhat medical services do you offer?*Check all boxes that apply. Medical evaluation and follow-up Emergency visits (<7 days access if needed) Monoclonal antibodies Medical cannabis Opioid management Other (Please specify)Other Medical ServiceDoes your clinic provide Botox treatment?* Yes NoIf your clinic provides Botox or other injection-based treatments, have the staff administering these procedures received formal training?** Yes NoMigraine Treatment Approaches - Estimated Breakdown For Migraine Canada's research purposes, please provide an approximate percentage breakdown of the migraine treatments provided in your clinic. The total should add up to 100%. If a treatment is not offered, you may enter 0%.Acute medication management (e.g., triptans, gepants, NSAIDs)Acute medication %*Preventive oral medications (e.g., beta-blockers, anticonvulsants, antidepressants)Preventive Medication %*OnabotulinumtoxinA (Botox) injectionsBotox %*Monoclonal antibodies (CGRP inhibitors)CGRP %*Nerve blocks (e.g., greater occipital nerve blocks)Nerve Blocks %*Neuromodulation devicesNeuromodulation %*Opioid management (for select or complex casesOpioid %*Medical CannabisCannabis %*Behavioral therapies (e.g., CBT, biofeedback, mindfulness)Behavioral %*Lifestyle & Wellness CoachingLifestyle %*Physical Therapy / rehabilitation interventionsPT %*Nutritional counselingNutrition %*Complementary or alternative therapies (e.g., acupuncture)Complementary %*Other (Please Specify)Other Approaches %*TotalYour total does not equal 100%What behavioral services do you offer?Please select only if the allied health care providers are working with you and you have a regular interaction with them, not if you refer to other independent clinics. Allied health care providers can be paid independently by patients. Check all that apply. Physical Therapy/Physiotherapy Biofeedback CBT, sleep CBT, Acceptance Commitment Therapy CBT, other Mindfulness Program Lifestyle management coach Nutritionist Occupational therapy Support groups Education Sessions OtherPlease specify (Other)*Do you provide medical expertise for purposes such as insurance claims, disability applications, or legal documentation?** Yes NoWhich types of referrals do you accept?Check all that apply. Patients who are self-referred Referrals from physicians (GP and specialists) Referrals through the hospital system only Referrals from any health care providerWhat is your typical wait time for a standard (non-expedited) headache referral?Select the most accurate option. <1 month 1-3 months 3-6 months 6-12 months >1 yearComments:Agreed to receive resources*By checking this box, I agree to receive my free Migraine Canada resource package. These patient-friendly materials are designed to help me better understand and manage my condition. Yes
