Migraine Episode Log

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Date:
Time migraine started:
Location of Pain – circle all that apply
Forehead: right left overall
Temple: right left both
Eyes: right left both
Back of Head
Top of Head
Other – describe
Severity of Pain
continued normal activities stopped some activities stopped all activities
Description of Pain
pounding
throbbing
aching
stabbing
pulsing
other – describe
Visual disturbances? Yes / No
describe:
Other sensory disturbances? Yes / No
describe:
Light sensitivity? Yes / No
Noise sensitivity? Yes / No
Felt nauseous? Yes / No
Actually vomited? Yes / No
What was I doing when migraine symptoms first started?

List foods, beverages, and medications taken before migraine symptoms started.

List actions taken to treat the pain:
1)
2)
3)
4)
5)
Did these actions help? Which ones were effective?

Duration of Migraine
Amount if any of work missed due to migraine
Describe any potential triggers that you can think of, (food, alcohol, menstrual cycle, noise, pollution, medications, sleeplessness, change in diet, etc.)




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