Chronic Migraine Resources (advertisement)
You can use a preprinted form, like the one below, or a regular calendar or notebook to record this information. Your doctor may recommend keeping such a diary every day for a week, a month, or the duration of your treatment. He or she may review the diary with you to assess your progress, weigh the effectiveness of medications, or make adjustments in your treatment plan.
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First episode |
Second episode |
Third episode |
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Date/day of the week of headache |
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Time of onset |
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Time of resolution |
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Warning signs |
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Location(s) of the pain |
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Type of pain |
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Intensity of the pain* |
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Additional symptoms |
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Activities/circumstances at time of onset |
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Time of most recent meal prior to onset |
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Food/drink most recently consumed prior to onset |
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Medication(s) taken for headache |
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Response to medication(s) |
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Other action(s) taken for relief |
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Response to action(s) |
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Last menstrual period** |
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Medication(s) currently taken for other condition(s) |
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*on a scale from 1 to 10, with 10 being the worst pain possible |
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Note: Permission is granted to reproduce this page of the report for individual use. |
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