Answer #3 - The diary is step one as I mentioned and it’s probably one of the single most important thing we can do in our first office visit. The diary should contain the dates that the patient gets the headache, the onset of the headache related to: for example in a woman, related to the onset of her menstrual cycle, her time of ovulation. In the diary they should also include any medication that they took for their headache, how long the medication took to be effective, if their headache recurred and ideally what I tell my patients is; when they had their headache, think back at least 24 – 12 hours before their headache occurred and on a separate piece of paper think about anything they ate or drank that may have been on the trigger list which I also give them with the diary and write down anything that may have potentially triggered that headache.

So that over a series of months we can see whether there is any recurring theme or pattern of something that triggers the headache. It’s useful for that reason. It’s also useful to see and follow whether there is a pattern of medication over-use. So for example when patients come into my office and they tell me they are taking 30 Tylenol per month they may be very surprised if they document their medication intake to find out they are actually taking maybe 40 or 50 Tylenol a month. But the other thing that it’s helpful for is to watch your headache pattern, so that for example when you are starting a patient on a prophylactic or preventative medication, you can actually follow what’s happening with your headaches over 3-4 months at a time.