A Migraine Headache Diary - how to keep one and interpret it.A Migraine Headache Diary can be a very helpful way of looking at headaches.Occasionally it reveals the true diagnosis, by showing a characteristic feature of one of the severe headache disorders such as hypnic headache or intracranial hypotension. A headache diary can help find out if headaches have have gone beyond ordinary migraine and into the area of chronic migraine. To keep a migraine headache diary requires a bit of organisation. To be of value should be kept for a minimum of a 2 weeks. You can download my version of the migraine headache diary for free here (no catches, just a pdf file for you to use). It does not matter if you do not catch every hour, or forget and go back and put in an entry after the event. It's the overall pattern that helps. A diary can also record the actual amounts of painkillers being taken and give some idea about whether they are actually helping. To me the main down side to keeping a headache diary is that it tends to focus people on their symptoms, and can become a obsession in itself. A diary is a helpful aid. It is no more than that. It is not an end in itself. However, it is very useful when trying to confirm a headache diagnosis, especially in chronic daily headache.
Headache Diary Pattern 1: An Episode of Tension-type Headache.
Tension-type headache is pressure or tightness in the head with no other significant symptom. It is not provoked by movement or exertion or coughing. It is short lived and in the mild-moderate range so many people do not even bother to take medication and can carry on with their normal activities. Headache Diary Pattern 2: An Episode of Migraine Headache.
In this migraine headache diary, pain builds fairly quickly to its maximum and reaches the severe end of the scale (more than 7/10 is classed as severe). In the comments people might record nausea or having to leave work and lie down. The following day a pain score of 1-3 is often recorded as the migraine settles down.
Headache Diary Pattern 3:Chronic Migraine
Note that there is never any time in the day when there is no pain - a background pain of about 5-6 is always present. About once a day or so the pain builds up to a severe level and there may be nausea or vomiting at that stage. This is a very common pattern to see this recorded every day for 2 weeks and would be very typical of chronic migraine. Headache Diary Pattern 4: Really Severe Constant Headache
This migraine headache diary does not really tell me anything except that this person is in a lot of distress about their headaches. I usually see this diary returned by people with chronic migraine who have reached their "wits end". However headaches like intracranial hypertension, hemicrania continua, cervicogenic headache or isolated sphenoid sinusitis might look like this. Making these diagnoses will depend on other features of the headache such as headache location, the quality of the headache and any provoking features. Headache Diary Pattern 5: Ice-pick Headache
Note there are sporadic moderate to severe spikes of pain only. Ice-pick pains last no more than a second or two and are unprovoked. A similar diary might be returned by someone with a Trigeminal Autonomic Cephalalgia like SUNCT or Paroxysmal Hemicrania. These severe headaches have other features that distinguishes them from Ice-pick pains. Headache Diary Pattern 6: Hypnic Headache
A person with Hypnic Headache goes to bed to sleep and is pain free. They are woken in the middle of their sleep with a moderate to severe level of headache that can last about an hour or two. When they waken in the morning they are usually pain free, but will definitely be painfree before the next night's sleep. Lithium Carbonate is the treatment that seems to work best - about 70% response rate in my own practice. Headache Diary Pattern 7: Episodes of Cluster Headache
Cluster Headache goes from no pain to maximal 10/10 pain~ in no more than about 5 minutes. It stays severe until effective treatment is given (Oxygen, sumatriptan injection) or it runs its course for between 30-180 minutes. It usually ends as quickly as it came on, although some will feel it taper as in this diary. Cluster Headache must have either eye watering, nasal symptoms, or agitation present to distinguish it from other intense headaches. Headache Diary Pattern 8: Second-Half-of-day Headache
Intracranial Hypotension causes a low pressure headache. This headache is worst when up and about and is relieved within minutes of lying completely flat. It can cause a chronic daily headache, but the diary can give away this pattern, and lead to successful treatment with an epidural blood patch.
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