Sunday, February 26, 2012

Migraine Diary


Migraine Management/Pain Diary
Date: ___________
Hrs of Sleep: _____ 
Quality of Sleep:  ______________________ 
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:  ____________________________________________________________________________________________________________________________________________________________________

1 comment:

  1. 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).