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Headache Diary Form Template

Effectively Track Your Headache Patterns with Ease

Keeping track of your headaches can be a challenge, but a simple headache diary can make it easier. This headache diary template is designed for individuals suffering from frequent headaches who want to identify patterns and triggers, leading to better management strategies. You can note down symptoms, medication use, and potential triggers, helping you discuss your condition more effectively with healthcare providers, gain insights into your headache patterns, and ultimately find relief. Try out the template to start recording your headache experiences.

Entry date
Did you have a headache today?
Yes
No
Number of headache episodes today
0
1
2
3
4 or more
Not sure
Most severe pain level today
Total duration of headache(s) today
Less than 30 minutes
30-59 minutes
1-2 hours
2-4 hours
More than 4 hours
Not applicable
Pain location (select all that apply)
Please Specify:
Pain quality (select all that apply)
Throbbing or pulsating
Pressure or tightness
Stabbing or sharp
Dull or aching
Burning
Electric or zapping
Not applicable
Other
Please Specify:
Symptoms experienced (select all that apply)
Please Specify:
Aura features (if any, select all that apply)
Zigzag lines
Blind spots
Flashing lights
Tingling or numbness
Speech difficulty
Not applicable
Other
Please Specify:
Onset pattern of the headache
Sudden (within minutes)
Gradual over 30-60 minutes
Gradual over several hours
Woke up with headache
Not applicable
Possible triggers today (select all that apply)
Please Specify:
Sleep last night
Less than 5 hours
5-6 hours
6-7 hours
7-8 hours
8-9 hours
More than 9 hours
Prefer not to say
Did you take any medication for headache today?
Yes
No
Acute medications taken (select all that apply)
Please Specify:
Non-drug strategies used (select all that apply)
Please Specify:
Overall relief from treatments today
No relief
Slight relief
Moderate relief
Significant relief
Complete relief
Not applicable
Side effects experienced (select all that apply)
Please Specify:
How much did the headache impact your day?
Not at all
A little
Somewhat
A lot
Completely
Not applicable
Time missed from work, school, or usual activities
None
Part of the day
Full day
Not applicable
Are you currently menstruating?
Yes
No
Not applicable
Prefer not to say
Other notes or observations
Follow-up reminder date
Suspected food triggers (select all that apply)
Please Specify:
Full name
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Colorful paper art illustration depicting a headache diary form template for FormCreatorAI article

When to use this form

Use this log when you want clear patterns for migraines, tension-type, or post-concussion headaches. Track each episode before a clinic visit, after a medication change, or during hormonal shifts, travel, or new work stress. Parents can monitor a child's symptoms for school nurse or pediatrician. It is also useful after a head injury to document duration, triggers, and relief methods. Bring the report to appointments, or pair it with a Neurological exam form to give your provider objective context. If you want a broader picture of wellness trends, complete a Self-health assessment form or a General health appraisal form alongside your entries. The result: faster decisions and a treatment plan tailored to you.

Must Ask Headache Diary Questions

  1. When did the headache start and end?

    Timing and duration reveal patterns, such as morning-onset or evening clusters, and show how long attacks last. This helps you and your clinician judge medication timing and effectiveness.

  2. Where is the pain located and how does it feel?

    Noting side, area, and quality (throbbing, pressure, stabbing, burning) points to likely types and guides care. It also highlights changes that may need follow-up.

  3. How intense was the pain (0-10)?

    A consistent scale makes your entries comparable over days and months. Clear severity trends support decisions about preventive therapy or dose adjustments.

  4. What happened before it began (sleep, stress, foods, screen time, weather, menstrual cycle)?

    Identifying triggers helps you test changes, like caffeine limits or earlier bedtimes, and see what actually works. Over time, you can prevent more attacks instead of only treating them.

  5. What did you take or try, when, and how well did it work?

    Recording medication name, dose, time, and side effects shows what brings relief and flags possible overuse. For a broader view of risks and habits, you can pair your log with a Health risk assessment questionnaire form.

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