Headache Diary

Headache diary plays an important role in the management of headache patients.  Drs. McKenzie and Cutrer from the Mayo Clinic compare patient recall of migraine headache frequency and severity over 4 weeks prior to a return visit as reported in a questionnaire vs a daily diary.   Here are some of their findings “Many therapeutic decisions in the management of migraine patients are based on patient recall of response to treatment.  As consistent completion of a daily headache diary is problematic, we have assessed the reliability of patient recall in a 1-time questionnaire.  209 patients completed a questionnaire and also maintained a daily diary over the 4-week period. RESULTS: Headache frequency over the previous 4 weeks as reported in interval questionnaires (14.7) was not different from that documented in diaries (15.1), P = .056. However, reported average headache severity on a 0 to 3 scale as reported in the questionnaire (1.84) was worse than that documented in the diaries (1.63), P < .001. CONCLUSIONS: In the management of individual patients, the daily diary is still preferable when available. Aggregate assessment of headache frequency in groups of patients based on recall of the prior 4 weeks is equally as reliable as a diary. Headache severity reported in questionnaires tends to be greater than that documented in daily diaries and may be less reliable. “

  1. Adrienne Samuels says: 08/01/200912:47 am

    To help in the identification of MSG food triggers, I recommend the list of the hidden sources of processed free glutamic acid (MSG) compiled by myself and my husband over the last 20 years: http://www.truthinlabeling.org/hiddensources.html

  2. Altan Loker says: 07/12/20093:48 am

    Migraine diary must cover the complete story of the illness and must include the events of the patient’s life that preceded each appearance of the symptoms and each change that occurred in them. Such information will expose the events to which the patient’s unconscious responds by producing the symptoms.

    Trying to terminate migraine symptoms using drugs constitutes a loosing fight against the patient’s mind. This is why migraine is currently uncurable.

  3. Dr. Mauskop says: 05/25/20098:44 pm

    It is important to look at actual patients behind any statistical analysis. For example, the efficacy of a particular treatment can be statistically significantly better than placebo, but the difference may appear very small. However, these results hide the fact that some patients do exceptionally well while others do not benefit at all. Similarly, many patients will be very accurate in their assessment of the severity of pain without a diary, but many will not. Since we do not know who will be good at recalling their pain and who will not it pays to have every patient keep a diary. The diary may also help identify potential headache triggers.

  4. X says: 05/24/200911:34 pm

    According to these numbers, patients reported headaches as being only 7% more severe than they recorded in their diaries. This is obviously a negligible difference and hardly warrants the conclusion you draw. Would a 7% increase in headache severity change your course of treatment? I doubt it.

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