treatment guide headache diary · consequently, it will be important to use this headache diary on...

First name & surname

TREATMENT GUIDEHEADACHE DIARY

.....................................................................................................................

DEAR PATIENT,

In order to correctly understand and treat your headache it will be important to

get an accurate and complete picture of your condition.

In addition to a neurological examination, the careful observation and accurate

description of your headache will play a major role in the success of your treatment.

Consequently, it will be important to use this headache diary on a regular basis.

As a result, the attending team will be able to design the best possible treatment

approach for you.

YOUR SUPPORT AND COOPERATION IS IMPORTANT!

Please use this diary on a daily basis in order to give your doctor a clear picture

of your situation. Treatment decisions will be made based on these results. Only

with your help and observations can your attending team make the best decisions

for your treatment.

HOW CAN YOU HELP?

Please use your diary on a regular basis – preferably every day. Fill in all the

information you can in the correct columns. If you have any questions on the completion

of the forms, please contact your doctor or the attending team.

HOW SHOULD YOU COMPLETE THE DIARY?

The diary is for recording different aspects of your headache, e.g. the pain intensity

or duration. Please note the month and day for each entry.

Headache days should ideally be marked with a cross in the appropriate box.

Example

You experience a moderately strong

headache on May 2nd. On the

following day, May 3rd, you

suffer from a migraine attack

with an extremely strong

headache which lasts for half

a day.

Pain intensity Duration Pain type Associated symptoms

Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull/

pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2 X X3 X X4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

3 2

THERAPY GUIDE HEADACHE DIARYTHERAPY GUIDE HEADACHE DIARY

Please note down respective numbers (triggers) or letters (medication) to track

your headaches and the action taken.

Example

On May 2nd, you took one 500 mg tablet of paracetamol for your moderately

strong headaches. You cannot identify a trigger for the pain. On May 3rd, you took

one 50 mg sumatriptan tablet at the start of the migraine attack. The migraine

attack was triggered by stress.

NOTE DOWN POSITIVE EXPERIENCES!

POSSIBLE TRIGGERS – LISTING

a. Mental and physical triggers

1 Excitement or stress

2 Recovery phase

3 Change in sleep rhythm

4 Menstruation

5 Other

...........................................................................................................................

...........................................................................................................................

...........................................................................................................................

b. Food/drinks as triggers

1 Cheese

2 Alcoholic beverages

3 Chocolate

4 Coffee, Coke

5 Other

...........................................................................................................................

...........................................................................................................................

.........................................................................................................................

c. Medication taken

Please note down any pain medication in the provided diary sections.

...........................................................................................................................

...........................................................................................................................

...........................................................................................................................

(c) Medication taken

Paracetamol Sumatriptan

If you have experienced something extremely positive or if you were able to do

something that had not been possible for a long time – note down these positive

events in your diary.

WHEN DO I NEED TO BRING ALONG MY DIARY?

Please make sure you bring along your diary to every appointment. Important

treatment decisions will be made based on your observations.

Thank you for your support!

B ..............................A ..............................

Schmerzstärke Dauer Schmerzart Begleiterscheinungen

Tag

leic

ht

mitt

el

star

k

extr

em s

tark

wen

iger

als

4h

meh

r al

s 4

h

puls

iere

nd/

poch

end

dum

pf/

drüc

kend

beid

seiti

g

eins

eitig

Übe

lkei

t

Erbr

eche

n

Lärm

sche

u

Lich

tsch

eu

Sehs

töru

ngen

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

Schmerzverstärkung bei körperl. Aktivität

Trigger Medication Dosierung WirkungFehlzeit

in StundenSchönesErlebnis

ja nein

Fill

in th

enu

mbe

r

Fill

in th

e le

t -te

r ac

cord

ing

to (

c)

Bitt

e A

nzah

l/M

enge

ange

ben

0 (k

eine

) –

4 (s

ehr

gut)

Aus

fallz

eite

nbe

i den

alltä

glic

hen

Tätig

keite

n

a b

1 BA

5 4


Month: .........................................................................................................................................................................


A ...................................................................................... B ...................................................................................... C ...................................................................................... D ......................................................................................


Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull

/ pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

DIARY

Name: .........................................................................................................................................................................

Increase of pain duringphysical activity

Trigger Medication Dose EffectMissing time

(in hours)Pleasant

experience

yes

no

Fill

in th

enu

mbe

r

Fill

in th

e le

tter

acco

rdin

gto

(c)

Fill

in th

enu

mbe

r/qu

antit

y

0 (n

one)

–

4 (v

ery

good

)

Failu

re r

ates

in d

ay-t

o-da

yac

tiviti

es

a b

7 6


Month: .........................................................................................................................................................................


A ...................................................................................... B ...................................................................................... C ...................................................................................... D ......................................................................................


Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull

/ pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

DIARY

Name: .........................................................................................................................................................................



(in hours)Pleasant

experience

yes

no

Fill

in th

enu

mbe

r

Fill

in th

e le

tter

acco

rdin

gto

(c)

Fill

in th

enu

mbe

r/qu

antit

y

0 (n

one)

–

4 (v

ery

good

)

Failu

re r

ates

in d

ay-t

o-da

yac

tiviti

es

a b

9 8


Month: .........................................................................................................................................................................


A ...................................................................................... B ...................................................................................... C ...................................................................................... D ......................................................................................


Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull

/ pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

DIARY

Name: .........................................................................................................................................................................



(in hours)Pleasant

experience

yes

no

Fill

in th

enu

mbe

r

Fill

in th

e le

tter

acco

rdin

gto

(c)

Fill

in th

enu

mbe

r/qu

antit

y

0 (n

one)

–

4 (v

ery

good

)

Failu

re r

ates

in d

ay-t

o-da

yac

tiviti

es

a b

11 10


Month: .........................................................................................................................................................................


A ...................................................................................... B ...................................................................................... C ...................................................................................... D ......................................................................................


Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull

/ pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

DIARY

Name: .........................................................................................................................................................................



(in hours)Pleasant

experience

yes

no

Fill

in th

enu

mbe

r

Fill

in th

e le

tter

acco

rdin

gto

(c)

Fill

in th

enu

mbe

r/qu

antit

y

0 (n

one)

–

4 (v

ery

good

)

Failu

re r

ates

in d

ay-t

o-da

yac

tiviti

es

a b

13 12


Month: .........................................................................................................................................................................


A ...................................................................................... B ...................................................................................... C ...................................................................................... D ......................................................................................


Day

mild

mod

erat

e

seve

re

extr

emel

y se

vere

less

than

4h

mor

e th

an 4

h

puls

atin

g /

thro

bbin

g

dull

/ pr

essi

ng

on b

oth

side

s

on o

ne s

ide

naus

ea

vom

iting

sens

itivi

tyto

sou

nd

sens

itivi

tyto

ligh

t

visi

ondi

sord

ers

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

DIARY

Name: .........................................................................................................................................................................



(in hours)Pleasant

experience

yes

no

Fill

in th

enu

mbe

r

Fill

in th

e le

tter

acco

rdin

gto

(c)

Fill

in th

enu

mbe

r/qu

antit

y

0 (n

one)

–

4 (v

ery

good

)

Failu

re r

ates

in d

ay-t

o-da

yac

tiviti

es

a b

15 14


TREATMENT INSTRUCTIONS

Date .................................................

Comments:

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

Medication Dose


Date .................................................

Comments:

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

Medication Dose


Date .................................................

Comments:

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

Medication Dose


Date .................................................

Comments:

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

.......................................................................................................................................................................

Medication Dose 17 16


NOTES

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

......................................................................................................................................................................

19 18


THE WEBSITE WWW.CHRONISCHEMIGRAENE.DE OFFERS MORE:

A service from

Handed over by:

DE-

BTX

-205

0186

, Dat

e: J

une

2020

A doctor search, tips and information about

chronic migraine can be found at: WWW.CHRONISCHEMIGRAENE.DE

• Comprehensive information about chronic migraine

• Advice from doctors for everyday life with the disease

• A self-test that can give the first indications of chronic migraine

• A doctor search that includes headache specialists throughout Germany

treatment guide headache diary · consequently, it will be important to use this headache diary on...

Documents