NeuroBali · Symptom monitoring
Diary template
Choose download language
Headache diary
A template for tracking headache frequency, duration, medicines used, triggers, and impact on daily activities.
Use your browser print dialog, choose 'Save as PDF' to save a copy.
Print this template and fill it daily for two weeks before consultation. Patterns over time are usually more meaningful than a single bad day.
How to fill it in
- Record entries soon after an attack ends; memory for details fades quickly.
- Intensity scale 0–10. 0 means no pain, 10 means the worst pain imaginable.
- Bring the diary to consultation or take a photo of each page to share beforehand.
| Day | Date | Start time | Duration | Intensity (0–10) | Location & pain type | Suspected triggers | Medication & dose | Medication relief (0–10) | Notes |
|---|---|---|---|---|---|---|---|---|---|
| 1 | |||||||||
| 2 | |||||||||
| 3 | |||||||||
| 4 | |||||||||
| 5 | |||||||||
| 6 | |||||||||
| 7 | |||||||||
| 8 | |||||||||
| 9 | |||||||||
| 10 | |||||||||
| 11 | |||||||||
| 12 | |||||||||
| 13 | |||||||||
| 14 |
Triggers commonly noted
- Too little or too much sleep, shifted sleep schedule.
- Skipped meals, dehydration, rapid caffeine changes.
- Stress let-down after deadlines or long travel.
- Hormonal: menstrual cycle, contraception, hormonal therapy.
- Weather changes, prolonged screen exposure, or strong odors.