Scribd
Upload
29 views

Headache

This document is a headache diary for the year 2019. It contains a table with the months of the year listed across the top and days of each month listed down the left side. There are blank spaces under each date to record medication changes or headache information for that day. The document instructs the user to "Mark medication changes below each month" and provides space at the bottom of each month to record totals or other notes.

Uploaded by

anaphotheqax
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
29 views

Headache

This document is a headache diary for the year 2019. It contains a table with the months of the year listed across the top and days of each month listed down the left side. There are blank spaces under each date to record medication changes or headache information for that day. The document instructs the user to "Mark medication changes below each month" and provides space at the bottom of each month to record totals or other notes.

Uploaded by

anaphotheqax
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
You are on page 1/ 2

Name: Mark medication changes below each month

2019 Headache Diary


January February March April May June
M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S
1 2 3 4 5 6 1 2 3 1 2 3 1 2 3 4 5 6 7 1 2 3 4 5 1 2
7 8 9 10 11 12 13 4 5 6 7 8 9 10 4 5 6 7 8 9 10 8 9 10 11 12 13 14 6 7 8 9 10 11 12 3 4 5 6 7 8 9
14 15 16 17 18 19 20 11 12 13 14 15 16 17 11 12 13 14 15 16 17 15 16 17 18 19 20 21 13 14 15 16 17 18 19 10 11 12 13 14 15 16
21 22 23 24 25 26 27 18 19 20 21 22 23 24 18 19 20 21 22 23 24 22 23 24 25 26 27 28 20 21 22 23 24 25 26 17 18 19 20 21 22 23
28 29 30 31 25 26 27 28 25 26 27 28 29 30 31 29 30 27 28 29 30 31 24 25 26 27 28 29 30
..............................................................................................

..............................................................................................
.............................................................................................. .............................................................................................. .............................................................................................. .............................................................................................. ..............................................................................................

..............................................................................................
.............................................................................................. ..............................................................................................
Totals: .............................................................................................. ..............................................................................................

Totals: Totals: Totals: Totals: Totals:

July August September October November December


M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S M T W T F S S
1 2 3 4 5 6 7 1 2 3 4 1 1 2 3 4 5 6 1 2 3 1
8 9 10 11 12 13 14 5 6 7 8 9 10 11 2 3 4 5 6 7 8 7 8 9 10 11 12 13 4 5 6 7 8 9 10 2 3 4 5 6 7 8
15 16 17 18 19 20 21 12 13 14 15 16 17 18 9 10 11 12 13 14 15 14 15 16 17 18 19 20 11 12 13 14 15 16 17 9 10 11 12 13 14 15
22 23 24 25 26 27 28 19 20 21 22 23 24 25 16 17 18 19 20 21 22 21 22 23 24 25 26 27 18 19 20 21 22 23 24 16 17 18 19 20 21 22
29 30 31 26 27 28 29 30 31 23 24 25 26 27 28 29 28 29 30 31 25 26 27 28 29 30 23 24 25 26 27 28 29
3 30 31
0
..............................................................................................
.............................................................................................. .............................................................................................. .............................................................................................. .............................................................................................. ..............................................................................................

..............................................................................................
.............................................................................................. .............................................................................................. .............................................................................................. .............................................................................................. ..............................................................................................

Totals: Totals: Totals: Totals: Totals: Totals:

Instructions SAMPLE CALENDAR


1.Headache commenced during sleep should be marked with a square. eg 2 nd

2.If headache starts whilst you are awake mark the date with a circle. eg 11 M T W T F S S

byAspenPharmacarestaffinnowayendorsesuseofanyproductbutisprovidedasaservicetothemedicalprofession
th

© 2009 Assoc. Prof. Paul Spira.


3.If the headache resolves in less than 1½ hrs strike out the day. eg 8 or 16 th th 1 2 3 4 5 6 7
4.Mark with * date of any change in headache medication and add detail in space
beneath the month. eg 26 * th
8 9 10 11 12 13 w 14

AF03612 ASP2014
Diary sponsored by
5. For females who menstruate, please underline your period days. eg 17 , 18 , 19 , 20 , 21

Disclaimer: Provision of the headache diary


th th th th st

6. If the headache lasts more than one day, please mark as follows. eg 4 , 5 , 6 , 7 th th th th
15 16 17 18 19 20 21
W
7. Any warning symptoms of an attack before retiring to bed mark with a ‘W’. eg 23 rd *
8. If you have a lesser headache mark as 14 and if this disappears within 1½ hrs mark as eg 14 th th
22 23 w 24 25 26 27 28
There is a short Video on how to complete this diary by Prof Paul Spira and more diaries are 29 30 31
available from the Patient Resources section at www.aspenpharma.com.au
PROPHYLACTIC FAILED ACUTE
MEDICATIONS PROPHYLACTIC PHASE INSTRUCTIONS
TO TRY MEDICATIONS THERAPIES

1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

11. 11.

12. 12.

13. 13.

14. 14.

15. 15.

16. 16.

17. 17.

18. 18.

TO BE COMPLETED BY DOCTOR
Aspen Australia is comprised of Aspen Asia Pacific Pty Ltd (ABN 75 146 444 484) and its subsidiaries, including Aspen Pharmacare Australia Pty Ltd (ABN 51 096 236 985), Aspen Pharma Pty Ltd (ABN 88 004 118 594), Aspen
Nutritionals Australia Pty Limited ACN 160607509, Orphan Holdings Pty Ltd (ABN 50 115 816 209), Orphan Australia Pty Ltd (ABN 11 067 189 342) and Aspen Products Pty Ltd (ABN 17 003 144 170). All sales and marketing
requests to: Aspen Pharmacare Pty Ltd, 34-36 Chandos Street, St Leonards NSW 2065. Tel: +61 2 8436 8300 [email protected] www.aspenpharma.com.au. Prepared: October 2018 AF03612 ASP2014

You might also like