Headache Tracker

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HEADACHE TRACKER
DATE
DATE
DATE
STEP 1
Keep track of your
headaches using this form
DURATION
DURATION
DURATION
for 1-2 weeks (you can print
extra forms if your
headaches are very
frequent).
TYPE OF PAIN (circle all that apply)
TYPE OF PAIN (circle all that apply)
TYPE OF PAIN (circle all that apply)
Aching
Aching
Aching
STEP 2
Dull
Dull
Dull
When the form is full, look
Pirecing Throbbing
Pirecing Throbbing
Pirecing Throbbing
at the horizontal rows to see
Squeezing
Squeezing
Squeezing
if there are any patterns in
Stabbing
Stabbing
Stabbing
the type of pain and
Sharp
Sharp
Sharp
potential causes you’ve
SEVERITY OF PAIN (circle one)
SEVERITY OF PAIN (circle one)
SEVERITY OF PAIN (circle one)
recorded.
STEP 3
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10
1 2 3 4 5 6 7 8 9 10
If you see patterns in the
MILD
SEVERE
MILD
SEVERE
MILD
SEVERE
headache triggers you’ve
noted, think about ways to
avoid the triggers. If you did
not see any patterns yet,
LOCATION OF PAIN (mark where it hurts)
LOCATION OF PAIN (mark where it hurts)
LOCATION OF PAIN (mark where it hurts)
you may want to keep
tracking your headache for
another week. You may wish
to speak to your doctor if
your headaches persist.
MEDICATIONS TAKEN
MEDICATIONS TAKEN
MEDICATIONS TAKEN
COMMON HEADACHE
TRIGGERS
Allergies/sinus
Alcohol consumption
Loud noises
Weather changes
Missing medications
Toxins/fumes/odors
HEADACHE TRIGGERS
HEADACHE TRIGGERS
HEADACHE TRIGGERS
Hunger
Fatigue
Eyestrain
Menstruation
Poor posture
Anxiety
Anger
FOODS EATEN PRIOR TO HEADACHE
FOODS EATEN PRIOR TO HEADACHE
FOODS EATEN PRIOR TO HEADACHE
Depression
Stress
EXERCISE OR ACTIVITIES PRIOR
EXERCISE OR ACTIVITIES PRIOR
EXERCISE OR ACTIVITIES PRIOR
TO HEADACHE
TO HEADACHE
TO HEADACHE
OTHER SYMPTOMS
OTHER SYMPTOMS
OTHER SYMPTOMS
COMMENTS/OBSERVATIONS
COMMENTS/OBSERVATIONS
COMMENTS/OBSERVATIONS

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