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Headache Diary

Record each headache episode with its time, length, intensity and the area affected. It also captures medication taken, possible triggers and how much the day was limited. After a few weeks of entries the clinical team can spot patterns and adjust treatment.

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Name

Nombre

Apellido

Gender

Female Male Other Prefer not to say

Details of the headache episode

Date

Time

Length of the episode (hours)

Were you menstruating that day?

Yes No Not applicable

Type of pain

Throbbing Stabbing Pressing Burning Dull and constant

Area where the pain was felt

Forehead Temples Back of the head One side of the head Behind the eyes Neck

Intensity of the pain

Not likely

1 2 3 4 5 6 7 8 9 10

Very likely

Did you take any preventive medication?

Yes No

Name of the medication

Number of doses taken

Name of the medication

Number of doses taken

Did you take any medication to relieve the pain?

Yes No

Name of the medication

Number of doses taken

Name of the medication

Number of doses taken

Other actions that brought relief

Possible triggers of the episode

Stress Lack of sleep Certain foods Alcohol Bright lights Weather change Long hours on screens Skipped meals

Please specify

Symptoms that came with the headache

Nausea Vomiting Sensitivity to light Sensitivity to sound Visual aura Dizziness Neck stiffness

How much did the pain limit your day?

I could do everything normally Mild limitation Moderate limitation Severe limitation I had to stay in bed

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