Headache Tracking 101: How a Simple Diary Can Help Diagnose Pain Patterns

Key Takeaways

• Data is Power: A headache diary minimises the likelihood of an uncertain diagnosis.
• Be precise: In addition to the level and site of pain, note possible triggers, such as food or stress.
• Extend Your Spectrum: Identify trigger candidates by looking for recurring patterns in your sleep, hydration, and hormones.
• Telemedicine is adjustable: a doctor's diary review can be conducted via a video call; therefore, there is no need for an in-person visit.
• Buyer Beware: Pay very close attention to any red flags, sudden, sharp changes in your pain pattern, and get immediate medical help.

One of the common complaints I hear as a GP is, "Doctor, I just keep getting these headaches."

Headaches are common, and yet, it is not easy to diagnose them during a brief 15-minute consultation. Could prolonged screen usage cause a tension headache? Is it a migraine out of the blue because of the weather? Or is it the effect of hormones, dehydration, or stress?

Many times, patients arrive recalling only part of the pain: "It happens a few times a month, usually in the afternoon." Which, although good, is not enough to reveal the whole story.

Therefore, a Headache Diary can become your primary asset in this situation. It changes your pain from something felt into something measurable and thus understandable. This article shows how a simple logbook can serve as a key, unlocking the pain management plan that suits you.

Documenting your headaches is the first step to successful treatment.

Just imagine that you will be able to recall each detail of a painful migraine, but as a matter of fact, the experience of pain can distort our memory of it. Our memory is selective; we tend to recall severe pain and forget less painful episodes, thereby producing a distorted picture. Besides the obvious convenience, keeping a record also serves the following three essential purposes:

• Diagnostic: Different types of headaches have distinct characteristics, or "signatures," associated with them. For instance, a migraine usually exhibits different symptoms from the ones you get with tension or cluster headaches. Determining the frequency and duration of the headache episodes can help categorise the type.
• Finding the trigger helps identify habits and patterns that would otherwise go unnoticed (e.g., "I always get a headache after the Team Meeting on Tuesdays").
• Managing headache frequency allows the doctor and patient to track whether lifestyle adjustments or recommendations are supporting overall well-being. The reduction in the number of headache days from 10 to 5 is already a success, but without the data, you might not 'feel' the difference.

If you have other chronic conditions you manage, you know that tracking is essential. It is like monitoring skin hydration to prevent dryness. The first step to prevention is raising awareness.

The Items to Be Included in a Headache Diary

There is no need to get a fancy app (though there are many); a plain notebook or a note on your phone is sufficient. The intention is to be consistent.

The Necessary Data:

• Date & Time: At what time did it begin? When did it end?
• Degree: Assign a pain severity score from 1 to 10.
• Area: Where is it hurting? (Is it behind one eye? Tightly wrapped around your forehead? The back of your neck?)
• Signs: Do you get nausea? Are you sensitive to light or sound? Do you have visual disturbances (aura)?
• Drugs: What did you take? Did it work?
• Women: Are you currently menstruating?

The "Context" Data:

• Sleep: How many hours were you sleeping the night before?
• Food/Drink: Did you skip a meal? Have you drunk enough water?
• Stress: Was it a super stressful day?

Systemic symptoms may accompany headaches. Some migraine sufferers, for example, experience digestive upset along with headaches. This can be a helpful indicator of your overall health if you include Gastrointestinal Health in your records.

Using Headache Diary for Identifying the Triggers

The more data you have collected, the better you will get at finding the culprits. Triggers vary from person to person. A certain aggravator in one person's migraine may be a remedy for someone else.

Common Triggers That You Can Identify in a Headache Diary

• Food Related: Caffeine (whether excessive amounts or caffeine withdrawal), alcohol (in particular red wine), aged cheese, or missing meals.
• Environment: Bright light, strong odours (perfume or smoke), or climate changes.
• Lifestyle: Among all the culprits, dehydration is a common trigger for headaches.
• Hormones: In many women's cases, there seems to be a very close connection between the menstrual cycle and their headaches.

The "Weekend Headache" Phenomenon

An average diary pattern shows what is commonly referred to as a "Saturday Morning Headache." Most often, this headache is caused by a sudden drop in stress hormone levels (this effect is also called "let down") or by a change in caffeine intake (waking up late and thus having the first coffee later than usual).

Interestingly, the influence of stress on the human body is manifold. As you know, stress can precipitate headaches; however, it may also exacerbate acne in adults. Therefore, by identifying stress as a factor through your diary, you will be able to take charge of more than one area of your health at the same time.

The Headache Diary as a Diagnostic Tool for Your Doctor

Simply bringing your medical record when you visit the doctor revolutionises the whole discussion. Instead of your doctor having to ask you all the standard questions, they would be only one or two questions away from confirming the diagnosis.

• Frequency: Managing headache triggers and reducing reliance on pain medications may help avoid worsening symptoms in a month. You should consider the possibility of "Chronic Daily Headache" or "Medication Overuse Headache".
• Time: Different types of investigations are required to find the cause of morning headaches versus those that start (or are present) late in the evening (e.g., 5 PM).
• Pattern: If the pain is splitting and accompanied by vomiting, then the condition is most probably a Migraine. On the other hand, if your headache is mild, compressive, and bilateral, it is a tension-type headache.

Healthdirect states that understanding the type of headache is crucial, as medications for migraine are ineffective for tension headaches, and vice versa.

How Telehealth Helps Keep Up With the Headache Diary and Treatment

Telehealth can be an effective method for managing headache-related issues. As the diagnosis often depends primarily on history and diary rather than on physical examination, we can perform much of the work remotely.

During a Telehealth Consultation, we can do the following:

• We can review your diary together after I receive it from you via email, or by sharing your screen with me.
• Discuss modifications to the lifestyle.
• Make changes to the treatment plan or the medication based on your condition.
• If required, we can schedule a neurologist appointment for you.

Hence, it is a time saver for people like business professionals and parents who are always very busy without even trying to go to the clinic whenever they suffer from migraine.

How to Review Your Headache Diary and Spot Patterns

My suggestion for reviewing your diary is to take a "Zoom Out" perspective only once a month.

Where is the "Cluster"?

Do your headaches stick together? Cluster headaches typically occur in cycles of weeks of daily attacks, followed by months of relief.

What is the "Slow Creep"?

Has the frequency of your headaches increased over a specific period? Your current management could be ineffective, or you may be developing resistance to the medication that you are using for acute relief.

Is there a "Lifestyle Link"?

Have your headaches become intense when you have insufficient sleep? This level of information can help you take control and realise that prioritising sleep gives you the best chance to prevent headaches.

As health changes emerge with age, it is crucial to recognise these patterns. More information on this topic is available in our article on Wellbeing Over 40.

Based on Your Headache Diary, When Should You Seek Medical Help

The majority of headaches are harmless, but your diary may reveal symptoms that require urgent medical attention, commonly referred to as "Red Flags".

Warning Signs Which Mean You Should See a Doctor Immediately:

• If the headache begins suddenly and is severe within seconds or minutes of onset.
• New Pattern: For those over 50, if an entirely new type of headache occurs.
• If the headache worsens in both severity and frequency, and medication no longer provides relief, it's time to seek medical attention.
• Neurological symptoms: such as weakness, numbness, confusion, or speech difficulties.
• Post Trauma: Headache is consistent with or started after a head injury

Please do not wait for your regular visit; if any of the above signs are present, go to the nearest emergency centre.

Note: Your health data is confidential, including what you monitor via apps or any platform you use. In this regard, we are cautious regarding data privacy.