Migraine Symptom and Treatment Tracking Log

Patient Information

Name: _________________ Date Started: ________________

Daily Tracking Sheet

Migraine Details

• Date and Time Started: //___ : AM/PM
• Date and Time Ended: //___ : AM/PM

Pain Characteristics

Pain Level (Circle): 1 2 3 4 5 6 7 8 9 10

Location (Check all): □ Right side □ Left side □ Both sides □ Front □ Back □ Temple □ Behind eye(s)

Associated Symptoms

□ Nausea □ Vomiting □ Light sensitivity □ Sound sensitivity □ Aura □ Dizziness □ Vision changes

Potential Triggers

□ Stress □ Sleep changes □ Weather changes □ Food/drink: ________________ □ Hormonal changes □ Other: ____________________

Treatment Used

Medications taken:

1. Name: ____________ Dose: _____ Time: _____
2. Name: ____________ Dose: _____ Time: _____

Non-medication treatments: □ Dark room □ Cold compress □ Sleep □ Other: ____________________

Treatment Effectiveness

Pain relief (Circle): None Slight Moderate Complete Time to relief: _____ hours

Notes

Bring this log to your next neurology appointment