Suggestions for customizing your Headache/Migraine Diary:

· Depending on the frequency of your headaches/Migraines, use a separate page per week or month.
· To effectively graph frequency and severity, separate the weeks and number them.
· I've entered sample data and a sample graph. You can modify to suit your needs.
· Review this document with your doctor. He/She may have suggestions.
· I select the last row of entries for one Migraine attack and single underline them so it's easier to read.
· I also double underline the cells of the last Migraine in a particular week, again to make it easier to read.
· You can also use the drawing tools to mark on the charts times when meds are changed.
· To print on standard paper, set up for landscape printing, .5 margins, no headers or footers.
Headache/Migraine Diary
Impact on activity ratings: 1 - 10 (less --> more)
Intensity of pain ratings: 1 - 10 (lowest --> highest)

Date Time Medication Time to

Headache Impact Intensity Taken Dosage Relief Triggers Comments

4/23/10 4:00 AM 1 1 sleep disrupt. Sense of aura - pain not triggered

4/24/10 4:00 AM 1 2 Slight pain
8:00 PM 1 2
4/25/10 4:15 AM 2 3
10:00 PM 2 3 Went to bed
4/26/10 1:15 AM 2 3
9:00 PM 2 3
4/27/10 3:30 AM 3 4 5 minutes Woke up from sleep due to acute pain
10:00 PM 2 3
4/28/10 3:30 AM 3 4 5 minutes Woke up from sleep due to acute pain
9:00 AM 2 3 5 minutes
6:00 PM 1 2
4/29/10 3:30 AM 2 3 Woke up from sleep due to acute pain
6:30 AM 4 5 10 minutes Significant pain
7:00 PM Cupping Sense of relief
9:15 PM 1 1 Sense of aura
4/30/10 1:15 AM 1 1 Sense of aura
6:00 AM 1 1 Sense of aura
9:00 AM 3 4 10 minutes Acute pain
8:15 PM 2 3 Went to bed
5/1/10 3:15 AM 2 3 Woke up from sleep due to acute pain
6:00 AM 3 4 10 minutes
1:00 PM I profin 1 Check at Hamad Hospital. After lunch
8:00 PM I profin 1 After dinner
10:30 PM 5 5 15 minutes Went to Hamad Hospital AlKhor. Diagnosed as cluster
5/2/10 1:15 AM 3 4 Diclofenac Potassium 1 5 minutes Not as acute as before. Keep taking deep breath
9:00 PM Diclofenac Potassium 1
5/3/10 9:00 PM Diclofenac Potassium 1
5/4/10 9:00 PM Diclofenac Potassium 1
5/5/10 4:30 AM 1 1
7:30 AM 6 5 Diclofenac Potassium 1 10 minutes
12:30 PM 5 4 Diclofenac Potassium 1 10 minutes
9:00 PM Diclofenac Potassium 1
5/5/10 5:30 AM 1 1 Diclofenac Potassium 1
12:00 PM 6 5 Diclofenac Potassium 1 10 minutes
9:00 PM Diclofenac Potassium 1
5/6/10 6:30 AM 6 5 Diclofenac Potassium 1 15 minutes
12:00 PM 5 4 Diclofenac Potassium 1 15 minutes
9:00 PM Diclofenac Potassium 1
5/7/10 6:30 AM 3 3 Diclofenac Potassium 1 10 minutes
5/8/10 6:00 AM Diclofenac Potassium 1
10:00 AM 2 2 5 minutes
5/9/10 6:00 AM Diclofenac Potassium 1
9:00 AM 2 2 5 minutes
5/10/10 6:00 AM Diclofenac Potassium 1
8:00 AM 2 2 5 minutes
5/11/10 6:00 AM Diclofenac Potassium 1 Sleep disruption
7:00 AM 6 5 1 hr
12:00 PM 6 5 40 minutes
7:30 PM 6 5 Diclofenac Potassium 1 15 minutes After waking up from sleep post maghrib
Headache/Migraine Diary
Impact on activity ratings: 1 - 10 (less --> more)
Intensity of pain ratings: 1 - 10 (lowest --> highest)

Date Time Medication Time to

HA/Migraine Impact Intensity Taken Dosage Relief Triggers Comments

10/8/02 9:30 AM 2 4 Imitrex tab 100 mg <> 45 min Weather minimal time from aura to pain
Phenergan 25 mg
10/11/02 3:00 PM 3 5 Imitrex tab 100 mg sleep disrupt.
Phenergan 25 mg
2 Migraines 4.5 avg intensity wk
Headache/Migraine Diary
Impact on activity ratings: 1 - 10 (less --> more)
Intensity of pain ratings: 1 - 10 (lowest --> highest)

Date Time Medication Time to

HA/Migraine Impact Intensity Taken Dosage Relief Triggers Comments
By Week
Week Week # Attacks Intensity Mo. Avg. Week Week # Attacks Intensity Mo. Avg.
Sept. 1 1 3 4.6 Jan. 5 19
Sept. 8 2 3 5.5 Jan. 12 20
Sept. 15 3 3 5.25 Jan. 19 21
Sept. 22 4 2 4.5 Jan. 26 22
Sept 29 5 2 4.5 4.87 Feb. 2 23
Oct. 6 6 2 4.5 Feb. 9 24
Oct. 13 7 Feb. 16 25
Oct. 20 8 Feb. 23 26
Oct. 27 9 Mar. 2 27
Nov. 3 10 Mar. 9 28
Nov. 10 11 Mar. 16 29
Nov. 17 12 Mar. 23 30
Nov. 24 13 Mar.30 31
Dec. 1 14 Apr. 6 32
Dec. 8 15 Apr. 13 33
Dec. 15 16 Apr. 20 34
Dec. 22 17 Apr. 27 35
Dec. 29 18 May 4 36

12
^ Effexor

10

0
2

0
 Month Attacks Intensity
Sept. 15 4.87
Oct.
Dec.
Jan.
Feb.
Mar.
Apr.
May
Jun.
Jul.
Aug.

16
^ Effexor
14

12

10

0
Sept. Oct. Dec. Jan. Column B
Feb. Column
Mar. C Apr. May Jun. Jul. Aug.