Ow my brain

August 9, 2010 2:04 PM

What information should be included in my headache journal?

I've been getting headaches for most of my life, but recently I've had worse and more frequent ones, and among other things my doctor suggested I start keeping a headache journal.

She just gave me a very basic sketch of what should be included in it. I've been looking online for templates, and I don't like any of them, so I'm going to make my own.

So my question is: what information should I include for a single entry in the journal? For things like what I've eaten, how far back should that go (all day, the day before, just a couple hours?). Should I include even minor 5 minute headaches that don't turn into anything? How detailed do I need to be in how bad it is over time (as they get worse and worse and then better and better - just the peak amount of pain or document how long it took to get there?)

I'd like to know answers both from a doctor's perspective (what will be helpful for my doctor to know) and from a patient's perspective (what will be helpful for me to know). If there's any spectacular guide online that you would like to link me to, that would be good too.

posted by brainmouse to health & fitness (18 answers total)

Definitely note at what point you are in your menstrual cycle. It took me an embarrassing number of years before I figured out that was the biggest indicator for me.
posted by something something at 2:16 PM on August 9, 2010 [1 favorite]

I've done this a few times. A few things I find useful: How was your sleep the night before the headache? (for me, not enough sleep = migraine). Is the pain on one side of my head, or both? I usually record roughly when the headache started, when I took medication, and how long it took to go away, if the meds actually worked.

If you think you might have migraines, you'll also want to keep an eye out for any of the non-headache symptoms that can go along with migraines. Were you nauseated? Light-sensitive or noise-sensitive? Any vision disturbances? Did you get really sleepy once the pain went away?

I'm not sure about the food; I've never been able to pinpoint any food triggers so at some point I stopped worrying about that. But I would probably start by trying to track the previous 24 hours or so of eating
posted by Stacey at 2:17 PM on August 9, 2010

Keep track of food as you eat it. Don't be trying to remember what you ate yesterday, especially not when you're in pain.

Ditto exercise. And the weather - rain, temperature and maybe humidity here.

What are you drinking. Write it down as you do it. Again, trying to recall x glasses of water, y cups of milk and z martinis from last night while your head is ouching you? You won't want to.

Regarding the headaches themselves, the more detail the better. ""1pm headache" is not as helpful as 1"pm 3/10, 1:30 5/10, 1:55 9/10 2:30 2/10" if your headaches happen in different parts of your head, note where each one is. Also record if you took anything for the pain and what was happening nearby when it started. Neighbors fighting? Stuck in traffic? What were you doing? Watching a laser show/middle of sexy times/lying down for a nap?
posted by bilabial at 2:19 PM on August 9, 2010

Oh, and I'd also include the amount of caffeine you've consumed that day.
posted by something something at 2:19 PM on August 9, 2010 [1 favorite]

Also, it may help to note how much water you drink. I had headaches, too, which mostly cleared up when I started drinking more water.

-- Good luck. I hate headaches and hope you find a solution.
posted by rw at 2:19 PM on August 9, 2010

For my experiences with such a diary, the more detailed the better. Sounds like you are looking at it as a diary of each headache, but it might be better to look at it as a diary of each day, with headaches included. That way, you are documenting everything you are eating, not just stuff you ate near a headache, for just one example.

It is a pain in the ass, but a great tool for solving the mystery of the pains in your head.
posted by thebrokedown at 2:20 PM on August 9, 2010

Keep a continuous journal, and note when the headaches come. Note down everything you eat, not just the stuff that you ate a while before the headache started. That way you can not only look for suspects, but you can rule others out.

Other things to note, at regular time(s) during the day if you can as well as at headache onset: weather, your heart rate/blood pressure if you have a way to take it, any meds (things you take once, things you take for the headache and how long they took to work, regular meds, when you begin a new med or stop an old one), anything unusual that happened that day (stress), anything else you can think of (a "misc" column).

I'm sure there's more.
posted by galadriel at 2:20 PM on August 9, 2010

With regard to what you have eaten, the relevant information would be, how long has it been since you last ate, and what did you eat then? Headaches can be associated with low blood sugar or other dietary abnormalities. They may be connected to lack of sleep or other forms of stress. They may be related to coffee consumption (too much or not enough), alcohol, or other drugs. If you notice anything at all that seems to be connected in some way to your headaches, make note of it. There are also headaches that do not seem to have any connection to anything that you are doing or experiencing, but even if that is the kind of headaches that you are having, that too is relevant data for a better diagnosis.
posted by grizzled at 2:21 PM on August 9, 2010

If you do anything that puts you in a high-heat situation -- hiking, working outside, long wait at the bus stop, broken AC at home or work -- I'd definitely include that. Also if you are outside in the sun a lot.
posted by amtho at 2:21 PM on August 9, 2010

When my dad was in the hospital after surgery, they asked him frequently what his pain felt like on a a scale from 1 to 10.

You should probabably sue this comparitive pain scale to rate your pain every four to six hours.

It's used to decide how effective pain management drugs are.
posted by rw at 2:25 PM on August 9, 2010

I would do it as a continuous journal.

Sleep: How much do you get, a 1-10 score of how well you slept. Do you go to sleep with a headache? Wake up with one? Do you get woken up by the pain?

Log everything for diet. What you eat and, when you eat paying attention to known triggers like refined carbohydrates, alcohol, caffeine etc. (I've been diagnosed with chronic migraines plus I've had an unrelenting headache that lasted 24/7 for 12+ years and, I found eating too many carbohydrates, especially of the refined variety, contribute to mine. YMMV).

Emotional states. Whether you've been angry, stressed etc lately.

If you use pain relievers which ones, how much was taken if at all and, whether it helped or not.

For the pain itself I'd include when it happened, how long it lasted for, how bad the pain was, where you felt it and, whether you also felt anything else like being dizzy, nauseous, confused, tired, dumb.

And, I'd log even the five minute headaches that don't lead to something worse.
posted by squeak at 3:05 PM on August 9, 2010

Ugh, I appreciate all the advice that a continuous journal is best, but there's just zero chance of me doing it. I know me well enough to know that it's just not going to happen. I can get motivated to write down what's going on when I get my headaches, but I just can't keep track of everything every day.

If it helps, I at most very rarely (once every couple months) consume alcohol or caffeine, and can state pretty authoritatively that those don't cause my headaches.
posted by brainmouse at 3:08 PM on August 9, 2010

I know me well enough to know that it's just not going to happen.

This is actually going to be a big problem if you want to use the journal to identify your triggers.

The point of a headache journal is to identify what's different between the times when you get a headache and the times when you don't. If you only record salient information when you have a headache, you won't have points of comparison. And I suspect that if it was something unusual about your routine or diet that triggers your headaches, you would at least have a suspicion of what it is by now--no, if your headaches are being triggered by something, it's something you see as normal.

I understand, completely, thinking that you just won't do it if it has to be continuous, because I'm the same way. And... sometimes I didn't. But all of my neurologists who wanted me to keep a headache journal stressed that it needs to be every day. I found it easier to keep up with it if I put it on my nightstand, and just made it a habit to spend five minutes before turning out the light.

As for information:

Things ingested, including ingredients if you know them. Don't worry about the ingredients of processed foods, because you can always look at the box again if you notice a pattern. But, for example, if you have a pasta dish, note down that the sauce was tomato and had sausage and zucchini in it. Rough estimate of when you ate it.

Time you get up with amount and quality of sleep of the night before.

Any unusual events or emotional states. If you don't follow your normal routine, note that down. If you feel unusually stressed, note that down.

Any headaches, any amount of medication or preventative action you took and whether or not it worked. Hit the major points of the headache: length, severity and type of pain, other symptoms, whether you had an aura.

None of this stuff needs to be "kept track of" with any particular effort. Just write it down at the end of the day.
posted by Kutsuwamushi at 4:41 PM on August 9, 2010

brainmouse I think why people keep using those foods as examples is they're the easiest to remember off the top of our heads. It's things like aged and fermented foods, sugar, foods that contain nitrates like bacon, ripe bananas ... there's quite a long laundry list. I'm not saying this is you, I only have my experience to go on, but I didn't see the correlation between mmm mac 'n' cheese until I scaled it back big time because I was rushing headlong into full blown diabetes if I didn't get my diet in check. I never considered the possibility the carbs were to blame, I thought I had already nailed all my triggers down as a lifelong migraine sufferer in my late teens. Oops.

The point of a headache journal is to identify what's different between the times when you get a headache and the times when you don't. If you only record salient information when you have a headache, you won't have points of comparison.

This. Plus, another part of it is it usually isn't one singular thing that starts the cascade its usually a combination that gets the ball rolling or, there are times where you can do something but won't wind up with a headache until days later but, by then you might have forgotten what it is you did that might have been a factor.

I've had to do it a number of times, I know its a slog and, I was dead set against doing it too, but it really does help to get to the bottom of why it's happening to you.
posted by squeak at 7:01 PM on August 9, 2010

You people and your "logic" and your "useful and helpful advice" that make me do more work :)

Really though, this has made me understand the point of the whole thing better, thanks all.
posted by brainmouse at 7:15 PM on August 9, 2010

I'm sorry, but you asked what would be most helpful to you and the doctor. A list of things you ate 1/2 hour before every headache is going to be useless without information about your physical activity, other food intake, hydration and sleep information.

Sleep defecit, for instance, is cumulative. Missing an hour a night for two or three nights might not seem like a big deal, but on day 6, potential whammy.

Start small. Record your waking and sleep times on a paper next to your bed. Keep the pen and paper there, don't move them.

After a week of that, continue the sleep journal, and also record on a piece of paper every glass of water. Keep that piece of paper and a golf pencil in your back pocket.

After a week of that, start recording your breakfast. If you always eat breakfast at home, keep this one sheet of paper on the fridge or on the counter.

Them start recording lunches, snacks, and dinners.

Yes, it won't be all together in one book. You'll have to compile them to bring to the doc. But you also won't be burdened by a big extra thing you're carrying around.

You can also write the days general weather on your bedtime sheet. "high of 102, rain, thunder," 3 days on a row with a headache on day four will possibly mean more than one day with a headache and the H day was clear and 97 degrees. It might be the change in weather is screwing you over. It could be anything.

Observing just the things you want to isn't likely to give you the best answer. It also is probably going to require you to record for a greater duration before finding any answers.

If there's anything appealing about continuing to have mystery headaches, collect as little information as possible, and you can say, "I have no idea why this could still be happening." if you want this to stop, find a way write everything down. Don't beat yourself up when at first you forget to record a meal, but make an effort to do better. Because you deserve a comfortable head, and you deserve to have someone looking after you.

It would be nice if that someone was someone else, but nobody else is going to record your mealtimes and sleeping habits.
posted by bilabial at 7:32 PM on August 9, 2010

On not preview, I see you've come around.

Yay.

You'll lick these headaches!

Good luck in this. (and thanks for taking the good natured arm twisting of ask.me so well.)
posted by bilabial at 7:35 PM on August 9, 2010

i see you've marked a best answer already, but i just wanted to say that you might want to take note of humidity/barometer stuff too. i get migraines (being successfully treated finally after years though--hurrah!) and they are definitely triggered by huge barometer jumps. so, something to be aware of that you might not have thought of.
posted by misanthropicsarah at 8:55 PM on August 9, 2010