How a Headache Diary is Helpful for Your Doctor

The Benefit of Headache Diaries Based on a Large Study

Keeping a Headache Diary. Tetra Images/Yuri Arcurs/Getty Images

It's not uncommon for headache specialists to recommend their patients use headache diaries to identify headache triggers. But what about a headache diary that helps a doctor diagnose the person's headache disorder -- is this really helpful?

One large headache study nicely explores this question. 

Headache Diary Study Design

In one international study in Cephalalgia, a basic diagnostic headache diary, or BDHD, was provided to over 600 patients from nine countries in Europe and Latin America.

The purpose of the study was to determine the diary's usefulness in diagnosing tension headache, migraine, and medical overuse headache -- which were defined within the diary using criteria from the second edition of the International Classification of Headache Disorders.

The BDHD was comprised of 15 questions . Here are some example questions:

  • "In the hour before it started, did you notice eyesight interference such as flashing lights, zigzag lines or blind spots?"
  • "Did physical activity (such as walking upstairs) make the headache worse?"
  • "Did you do anything, or did anything happen that may have caused the attack?"

In this study, one group (Group 1) of patients was asked to complete the BDHD starting at least one month prior to their doctor's appointment, while another group (Group 2) did not receive the BDHD. The patients then met with a doctor for a history and physical examination.

Headache Diary Study Results

Nearly all the patients and physicians participating reported the BDHD as easy to understand.The majority of patients also found the diary helpful, especially in making them aware of when they were using medications to treat their headaches.

The diary was not as helpful in understanding headache triggers or deciding when to treat a headache.

Also, in combination with the doctor's interview with the patient, the BDHD was considered  "adequate  for the diagnosis of almost 96 percent of patients."  In addition, the use of the BDHD increased the likelihood that a patient was diagnosed with more than one headache disorder, which is common among patients visiting headache clinics.

Most interesting is that when the the diagnoses made from the diaries alone were compared to the diagnoses made from the doctor-patient interviews alone, there was an extremely high rate of agreement between them.

So...Should a Diary Replace a Doctor's Visit?

Absolutely not. The fact that there was a strong agreement on diagnoses between the diaries alone and the doctor-patient interview alone does not imply that the diary should be used in place of a doctor visit.

For one, the neurological exam performed by a physician is critical in ruling out serious secondary headaches that can mimic primary headache disorders, like migraine. Secondly, a patient's own words during an appointment may provide extra clues to a diagnosis and, like the neurological exam, are vital in helping a doctor rule out more serious causes of headaches.

More Questions on Headache Diaries

There are still questions regarding the best way to utilize headache diaries:

  • Should there be separate diaries for helping a person identify headache triggers vs diagnosing a type of headache
  • Should children use headache diaries?
  • Is there a difference in usefulness between hand-written and electronic diaries?
  • Is the time frame of one month appropriate for a headache diary? Is it enought time to diagnose a chronic headache disorder? Would a longer time frame be too burdensome for the headache sufferer?

The Bottom Line

A headache diary may be helpful in diagnosing and managing a person's headache disorder. If you are interested in starting a headache diary, there are some excellent headache diary samples available through the American Headache Society. Share your diary with your doctor to optimize your headache health.

Sources:

Jensen, R. et al. (2011). A basic diagnostic headache diary (BDHD) is well accepted and useful in the diagnosis of headache. a multicentre European and Latin American study. Cephalalgia, Nov;31(15):1549-60.

American Headache Society. (2011) Headache Diaries.

DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

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