Print the chart and use it to record the date, severity and duration of each headache, together with the medication used each time. You can also record the response to treatment (effect of medication) and, if recognized, the trigger factor(s) for the attacks. Use the monthly headache calendar to create a summary.
DATE:

TIME OF DAY

TIME

S
E
V
E
R
I
T
Y

D
U
R
A
T
I
O
N

MEDICATION TAKEN

E
F
F
E
C
T

TRIGGER FACTORS
Morning            
Afternoon            
Evening            
Sleeptime            
DATE:

TIME OF DAY

TIME

S
E
V
E
R
I
T
Y

D
U
R
A
T
I
O
N

MEDICATION TAKEN

E
F
F
E
C
T

 TRIGGER FACTORS
Morning            
Afternoon            
Evening            
Sleeptime            
Severity:
Mild headache = 1, moderate headache = 2, severe headache= 3

Effectiveness:
None = 0, slight relief = 1, moderate relief = 2, complete relief = 3

For more information, click on how to use a headache calendar.

Calendar courtesy of The New England Centre for Headache

Request a Refill

11 + 9 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.