Headache diary: effective treatment in Ternopil

Instructions for filling out the diary

Before your consultation, it is very important that you fill out this diary daily. The information you enter in the diary will help your doctor make a correct diagnosis, determine the severity of your headache (HBP), and promptly prescribe the optimal treatment for you.

At the top, write your name (full name), date of birth, and the date you started filling in the diary. Then, opposite Question 1, in the 1st column, write the date (day of the month) you filled in the diary. You can put dates in all the columns at once, since you will have to fill it in every day. Please fill in the diary every night before going to bed, checking [√] the boxes (□) in the vertical column. This data is a summary of any headaches that occurred that day. If you did not have a headache that day, answer only Questions 2 and 15. If you have finished filling in one page of the diary, please continue on the next page (several copies are attached).

Below are instructions for answering the questions.

• Enter only the number (for example, 12); the month and year do not need to be specified.
• Check “Yes” or “No” in the boxes opposite all questions, or go straight to Question 15 (if there was no GB that day).
• Enter the time (hour in 24-hour format) when you first noticed the onset of the headache. If you woke up with a headache, enter the time you woke up. (If the morning headache is a continuation of the evening headache, put an X in the column.)
• Enter the time (hour and minutes in 24-hour format) when the headache completely stopped. If the headache was still present at bedtime that day, leave the box blank. If the headache was absent in the morning, enter the time you went to bed. If the headache was present in the morning, put an X in the box for that day and also an X in the box for Question 3 in the next column. Continue your records the next day as usual.
• Some people experience some visual disturbances within 1 hour of the onset of a seizure. These may include flashes of light, zigzag lines, blind spots, or black holes that are present even when the eyes are closed. Check “Yes” if you have experienced any of these, or “No” if you have not. If you are simply irritated by the light (see Question 12) and nothing more, check “No.”
• Check the box that corresponds to the location of the headache (mostly on one side of the head or both sides).
• Although there are many descriptions of the nature of GB, most are either “throbbing” (the pain intensifies with the heartbeat) or “tight” (like a “hoop” or “helmet”). Check the characteristic that best describes the type of GB you have.
• Some types of GB are aggravated by even minor physical exertion (for example, when climbing stairs) or cause the person to avoid such activity. Check “Yes” if this applies to your GB, and “No” if this is not typical for you.
• The intensity (strength) of the pain is an important component of the diagnosis. Rate the strength of your pain by checking the appropriate box if: “mild” pain is pain that does not interfere with your normal activities (i.e. your ability to work and your usual activities), “severe” pain makes it difficult, but does not completely prevent you from doing your usual activities, and finally, “very severe” pain is pain that completely interferes with your normal activities. Try to rate the intensity of your pain throughout the day. For example, if the pain was mild in the morning and then became very severe, check the box “severe”. If the pain was very intense for most of the day, check “very severe”.
• Mark “No” if you had no nausea at all during the day. If you had mild nausea that hardly bothered you, did not cause belching or vomiting, mark “minor”, in case of more pronounced nausea – “noticeable”.
• Check “Yes” or “No.” Burping and retching are not considered vomiting.
• The question is about normal daylight or room light, not very bright light. Mark “Yes” if normal light bothered you or you tried to avoid it by darkening the room or wearing dark glasses. Otherwise, mark “No.”
• The question is about normal noise, not very loud sounds. Mark “Yes” if the noise bothered you or you tried to avoid it by going to a quiet room. Otherwise, mark “No.”
• Please list any factors that you think may have caused your GERD. Maybe you ate something, drank something, did something (e.g., missed dinner, had a sleepless night, worked out physically) or there were other causes (change in weather, stress, menstruation).
• List the names of any medications (pills, suppositories, injections, nasal sprays) you have taken for headache or other pain. For each medication, list the number of doses taken, and the time (hours in 24-hour format) you took each medication. Do not list medications you have taken for other conditions.

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