Migraine Management/Pain Diary
Date: ___________
Hrs of Sleep: _____
Quality of Sleep: ______________________
MedsTaken________________________________________________________________________
Overall Health Today: 1 2 3 4 5 (1=Excellent, 5=Poor)
Migraine Pain Rating: 1 2 3 4 5 6 7 8 9 10 (1=Mild, 10=Debilitating, Worst Pain Ever)
TIme Migraine Began: _______________________
Time MigraineEnded:____________________
During Menses (y/n) _________
Weather Today: ________________________________________
Any Food/Drink Triggers Consumed Today:_______________________________________
Location of Pain: __________________________________________________________
Description of Pain: ________________________________________________________
Symptoms Associated with Migraine: ___________________________________________________________________________________________________________________________________________________________
Activities Done Today: ____________________________________________________________________________________________________________________________________________________________________
Activities Eliminated Due to Migraine/Physical Health: ____________________________________________________________________________________________________________________________________________________________________
Feelings Today: ____________________________________________________________________________________________________________________________________________________________________
You can copy, paste and print this all you like if you like it. You will have to fix the lines/margins a bit; they got messed up during transference I guess... Anyway, I found a diary a little while back similar to this one, then, I cut out what I thought was unnecessary, added a few things and whala! I think this one is particularly useful if you are applying for disability (as I am) because it is very specific and if you have comorbid conditions like anxiety, depression, etc. (as I do).
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