The Horowitz Lyme-MSIDS Questionnaire


Richard Horowitz


Dr. Richard Horowitz developed the Horowitz Lyme-MSIDS Questionnaire as an informational tool to help you determine if you may have Lyme disease or chronic illness.

Horowitz Book

Horowitz Lyme-MSIDS Questionnaire*

Section 1: Symptom Frequency Score

0 None
1 Mild
2 Moderate
3 Severe

  1. Unexplained fevers, sweats, chills, or flushing
  2. Unexplained weight change; loss or gain
  3. Fatigue, tiredness
  4. Unexplained hair loss
  5. Swollen glands
  6. Sore throat
  7. Testicular or pelvic pain
  8. Unexplained menstrual irregularity
  9. Unexplained breast milk production; breast pain
  10. Irritable bladder or bladder dysfunction
  11. Sexual dysfunction or loss of libido
  12. Upset stomach
  13. Change in bowel function (constipation or diarrhea)
  14. Chest pain or rib soreness
  15. Shortness of breath or cough
  16. Heart palpitations, pulse skips, heart block
  17. History of a heart murmur or valve prolapse
  18. Joint pain or swelling
  19. Stiffness of the neck or back
  20. Muscle pain or cramps
  21. Twitching of the face or other muscles
  22. Headaches
  23. Neck cracks or neck stiffness
  24. Tingling, numbness, burning, or stabbing sensations
  25. Facial paralysis (Bell’s palsy)
  26. Eyes/vision: double, blurry
  27. Ears/hearing: buzzing, ringing, ear pain
  28. Increased motion sickness, vertigo
  29. Light-headedness, poor balance, difficulty walking
  30. Tremors
  31. Confusion, difficulty thinking
  32. Difficulty with concentration or reading
  33. Forgetfulness, poor short-term memory
  34. Disorientation: getting lost; going to wrong places
  35. Difficulty with speech or writing
  36. Mood swings, irritability, depression
  37. Disturbed sleep: too much, too little, early awakening
  38. Exaggerated symptoms or worse hangover from alcohol

Section 1 Total:

Section 2: Most Common Symptoms

If you rated a 3 for each of the following in Section 1, give yourself 5 additional points:

  1. Fatigue
  2. Forgetfulness, poor short-term memory
  3. Joint pain or swelling
  4. Tingling, numbness, burning, or stabbing sensations
  5. Disturbed sleep: too much, too little, early awakening

Section 2 Total:

Section 3: Lyme Incidence Score

Now please circle the points for each of the following statements you can agree with:

  1. You have had a tick bite with no rash or flulike symptoms. 3 points
  2. You have had a tick bite, an erythema migrans, or an undefined rash, followed by flulike symptoms. 5 points
  3. You live in what is considered a Lyme-endemic area. 2 points
  4. You have a family member who has been diagnosed with Lyme and/or other tick-borne infections. 1 point
  5. You experience migratory muscle pain. 4 points
  6. You experience migratory joint pain. 4 points
  7. You experience tingling/burning/numbness that migrates and/or comes and goes. 4 points
  8. You have received a prior diagnosis of chronic fatigue syndrome or fibromyalgia. 3 points
  9. You have received a prior diagnosis of a specific autoimmune disorder (lupus, MS, or rheumatoid arthritis), or of a nonspecific autoimmune disorder. 3 points
  10. You have had a positive Lyme test (IFA, ELISA, Western blot, PCR, and/or borrelia culture). 5 points

Section 3 Total:

Section 4: Overall Health Score

  1. Thinking about your overall physical health, for how many of the past 30 days was your physical health not good?________ days

Award yourself the following points based on the total number of days:

0-5 days = 1 point
6-12 days = 2 points
13-20 days = 3 points
21–30 days = 4 points

  1. Thinking about your overall mental health, for how many days during the past 30 days was your mental health not good?________ days

0–5 days = 1 point
6–12 days = 2 points
13–20 days = 3 points
21–30 days = 4 points

Section 4 Total:

Section 5: Scoring

Record your total scores for each section below and add them together to achieve your final score:

Section 1 Total:
Section 2 Total:
Section 3 Total:
Section 4 Total:

Final Score:

Section 6: Data Interpretation

If you scored 46 or more, you have a high probability of a tick-borne disorder and should see a health-care provider for further evaluation.

If you scored between 21 and 45, you possibly have a tick-borne disorder and should see a health-care provider for further evaluation.

If you scored under 21, you are not likely to have a tick-borne disorder.

Interpreting the Results

We see a high frequency of Section 1 symptoms in our patients, including fatigue, joint and muscle pain that often migrates, sleep disorders, as well as memory and concentration problems, and a high frequency of Section 3 symptoms, especially neuropathic pain that comes and goes and migrates (tingling, numbness, burning, etc.). These form a cluster of presenting symptoms that are characteristic of those with a high probability of having Lyme-MSIDS.

In one recent study conducted in our office of 100 consecutive patients, we found that more than 25 percent reported that the following symptoms were present most or all of the time in the month preceding their office visit. Many of these patients reported that these symptoms affected their quality of life: 71 percent reported that their physical health was not good and 47 percent reported that their mental health was not good on at least 15 days in the previous month.

*The Horowitz Lyme-MSIDS Questionnaire is not intended to replace the advice of your own physician or other medical professional. You should consult a medical professional in matters relating to health, and individuals are solely responsible for their own health care decisions regarding the use of this questionnaire. It is intended for informational purposes only and not for self-treatment or diagnosis.

© Richard Horowitz.



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