pediatric headache diary pdf
HOLYOKE PEDIATRIC ASSOCIATES LLP 150 Lower Westfield Road 84 Willimansett Street Holyoke MA 01040 South Hadley MA 01075 413 536-2393 413 532-0300 HEADACHE. This not e will note be on the printout.
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The Boston Childrens Hospital patient resources website offers information on a wide array of support services available to families at Boston Childrens.
. Stress mood changes dehydration and lack of sufficient sleep may contribute to headaches What is different about headaches in children than adults. Warning Signs aura Location of Pain. Foods or beverages containing caffeine.
Pediatric Headache Program Resources. DateWeek Day Onset Time Severity. Atkins Lisa Created Date.
Medication-oeruse v headache MOH Headache occurring on 15 or more days per month developing as a consequence of regular overuse of acute or symptom-atic headache medication on 10 or more or 15 or more days per month depend-ing on the medication for more than 3 months. Each time you have a headache answer these questions in your headache. 352009 100251 PM.
Please list anything that you suspect may be triggering or contributing to your headaches on your headache diary. HEADACHE DIARY Keep track of your headaches. Ask your parent or other adult to help you with this diary.
A headache diary can include information on a range of things however its often best to keep it simple and record basic information. Progress becomes more obvious when we compare week to week or month to month rather than hour to hour or day to day so the diary. 1- Mild headache 2- BusinessSchool Problem B- Chocolate 2- Moderate headache 3- Vacation C- Fermented foods.
Mild headache not impairing ability to function- Might not have mentioned it without diary. Headache completely gone within 30 minutes 2. Can be on a piece of paper calendar or for smart phone uses try a migraine tracking app o Migraine uddy Manage My Pain Pro Migraine Insight Migraine Monitor etc Make note of some important details about each headache.
It helps the doctor be able to treat them. Please make sure that IF you need glasses or a new prescription that you have the correct prescription and wear your glasses EVERY DAY. Headache Diary Print this form so that you can track your headaches for a month.
A Headache diary is useful to record. You also may be able to find out what your headache triggers are such as certain foods stress sleep problems or physical activity. Headaches in Children - 2 - spots in vision difficulty moving or with balance or tingling of a body part.
Headache TimeDuration startfinish Location of pain Intensity of pain on a scale of 1 to 10 10 being the worst Activities or. Use a scale of 0-10 where 0 is no pain and 10 is the worst pain you can imagine. Keeping a headache diary may help you understand what types of headaches you get and what treatment works best for you.
Time of Headache Time Headache Ended. Headache Diary Date. A Headache diary is useful to record.
The frequency duration and severity of headaches any triggers or precipitating factors and to monitor the effectiveness of headache interventions. Day of the week. Headache caffeine diet soda chocolate hot dogs food with artificial sweeteners processed foods Important Stressful Events that Occurred Today.
Moderate headache not impairing ability to function- Able to go to school do work and activities- but with noticeable discomfort. Resources outside of Boston. Please fill out the diary every day on which you experience any head pain and remember to bring it in on your follow up visits.
Headache completely gone. Please fill out the diary every day on which you experience any head pain and remember to bring it in. Record the strength of your headache pain.
Scans of the head do not help in the diagnosis of migraine. Keeping a headache diary may help you learn more about your childs situation. Duration how long the attack lasted severity how bad the attack was.
This will also help you and your health provider make a plan for treating your headache. Angela Lassetter Created Date. Page 1 is the diary Page 2 is the key Pages can be printed separatel y if you need multiple copies of the diary but only one copy of the key - just select in the box that comes up when you click print.
Record the number of headaches you had during this day. Please list what makes it BETTER and what makes it WORSE. The list may help to increase awareness of issues in your life that could be contributing to your headaches.
Rest or sleep 1. Headache diary helps doctors decide about the diagnosis and management. Type of Pain pressing throbbing piercing etc.
Keeping a headache diary is very important to help track progress in managing headaches. HEADACHE DIARY DUPLICATE AS NEEDED DATE TIME BEGAN TIME ENDED TRIGGERS SYMPTOMS 1-photophobia 2- phonophobia 3- nausea 4- vomiting 5- dizziness OTHER SYMPTOMS describe TREATMENT relieved or not QUALITY pulsing pounding stabbing dull ache tightness Title. Please list the TIME and DATE the headache STOPS.
Add more pages as you need them. Headache make notes in your diary. 50 Printable Headache Diary Templates Word Pdf Printabletemplates Moderate headache not impairing.
This information will help you and your healthcare provider learn about your headaches. Young children may not be able to tell you where it hurts. To learn more about headaches we invite you to read our headaches page.
Scans of the head do not help in the diagnosis of migraine. Use a separate line for each new headache. Headache Service Department of Neurology St Georges Hospital Blackshaw Road London.
HOLYOKE PEDIATRIC ASSOCIATES LLP 150 Lower Westfield Road 84 Willimansett Street Holyoke MA 01040 South Hadley MA 01075 413 536-2393 413 532-0300 HEADACHE DIARY Name DOB. 50 Printable Headache Diary Templates Word Pdf Headache Diary Diary Template Headache. It usually but not invariably resolves after the overuse is stopped.
Please list TIME and DATE the headache STARTS. This can either be recorded as mild moderate or severe. Or on a scale from 1-10 where 10 is.
A headache diary consists of tracking the following information. List all other foods eaten within 6-12 hours prior to headache onset 1. Write down the following details about your headache.
Headache Diary Date time started Severity Headache Triggers Relief Measures Other comments. Print this migraine andor headache diary and use it to keep track of your headaches or migraines. Severe headache impairing ability to function- Not able to go to school play or do enjoyable activitiesNeed to lay down and rest.
Warning Signs aura Medication time and dosage Stressors HEADACHE DIARY Feel free to print multiple copies for your personal use to track the following information.
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