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Headache Diary and Management Tracking Tool

A comprehensive tool for monitoring headache patterns and triggers

Neurology

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: ___________________ Date Started: //___

Daily Headache Log

Date and Time

  • Date: //___
  • Time Started: _____ Time Ended: _____

Pain Characteristics

  • Intensity (0-10): ____
  • Location (check all that apply): □ Right side □ Left side □ Both sides □ Front □ Back □ Temple □ Other: _____

Associated Symptoms

□ Nausea □ Vomiting □ Light sensitivity □ Sound sensitivity □ Visual disturbances □ Other: _____

Potential Triggers

□ Stress □ Sleep changes □ Dietary factors □ Weather changes □ Hormonal factors □ Exercise □ Screen time □ Other: _____

Treatment Used

  • Medication name: _____
  • Dose: _____
  • Time taken: _____
  • Relief achieved (0-10): _____

Impact on Daily Activities

□ No impact □ Mild interference □ Moderate interference □ Severe interference □ Complete disability

Monthly Summary

Total headache days: _____ Worst intensity experienced: _____ Most effective treatment: _____

Bring this log to your next neurology appointment

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