From the Research
A headache diary is highly recommended for tension-type headache management. Patients should record each headache episode, noting the date, time, duration, intensity (on a scale of 1-10), location, associated symptoms, potential triggers (stress, sleep disturbances, posture, meals), and any medications taken with their effectiveness. This diary should be maintained for at least 4-8 weeks initially, then periodically during treatment changes. The diary helps identify patterns and triggers that might otherwise go unnoticed, allowing for more targeted lifestyle modifications and treatment approaches. It also provides objective data for healthcare providers to assess treatment efficacy and make appropriate adjustments. Additionally, the diary can reveal medication overuse patterns, which is important as excessive use of analgesics (more than 15 days per month for simple analgesics or 10 days for combination medications) can lead to medication-overuse headaches. The act of maintaining a diary also engages patients actively in their care, potentially improving treatment adherence and outcomes. According to the most recent and highest quality study 1, the usefulness and applicability of a basic headache diary before the first consultation have been tested, and the results suggest that it is a valuable tool for diagnosis and treatment.
Some key points to consider when using a headache diary include:
- Recording headache episodes with details such as date, time, duration, and intensity
- Noting associated symptoms and potential triggers
- Tracking medications taken and their effectiveness
- Maintaining the diary for at least 4-8 weeks initially, then periodically during treatment changes
- Using the diary to identify patterns and triggers, and to assess treatment efficacy
The European Federation of Neurological Societies (EFNS) guideline on the treatment of tension-type headache also recommends the use of a headache diary as part of the treatment approach 2. Overall, the evidence suggests that a headache diary is a useful tool for managing tension-type headache, and its use is highly recommended.