How to Keep a Headache Diary That Actually Helps in Kathmandu

A headache diary is the single most useful tool for anyone with frequent headaches —— yet most diaries are either too complex to maintain or too simple to be clinically useful. The diary that actually helps balances completeness with practicality.

What to track: Record every headache episode with these fields: date and time of onset, duration (hours or days), severity (0——10 scale or mild/moderate/severe), location (one side, both sides, around the eye, front, back), associated symptoms (nausea, vomiting, light sensitivity, sound sensitivity, visual changes, neck pain), possible triggers in the preceding 24 hours (stress, poor sleep, missed meals, dehydration, alcohol, weather change, hormonal factors, strong smells, screen time), and medication taken with dose and relief (partial, complete, or none). Also note days without headache —— the frequency calculation requires knowing the total days recorded.

Dr. Jitendra Prasad Yadav — consultant neurologist & headache specialist at Kathmandu Neurology Clinic & Cognitive Center provides evidence-based evaluation for migraine.

How to use it effectively: Record each headache on the day it occurs —— retrospective recall by even one or two days is unreliable and leads to undercounting. Keep the diary in a format you will actually use: a paper notebook kept by the bed, a notes app on your phone, or a structured template. Consistency matters more than perfection. Four to eight weeks of data gives enough pattern for clinical decision-making; one or two headache days are insufficient for classification.

Digital vs paper diaries: Paper diaries are simple, require no battery, and can be brought to appointments. Digital apps can calculate frequency automatically and remind you to record. Neither is superior —— the best diary is the one you will complete. At Kathmandu Neurology Clinic, Dr. Jitendra Prasad Yadav (NMC 8029) reviews whichever format the patient brings and enters the data into clinical records for longitudinal tracking.

What the doctor looks for in the diary: Headache frequency (days per month), duration of individual attacks, severity distribution, presence of migrainous features (nausea, photophobia, phonophobia, aura, worsening with activity), medication days (simple analgesics, triptans, combination analgesics, opioids), and the relationship between triggers and attacks. The diary also reveals medication-overuse patterns —— headache on 15+ days per month with analgesic use on 10——15+ days per month suggests the medication itself is perpetuating the headache, a finding that changes management completely.

How it guides treatment decisions: A diary showing 8 migraine days per month with disability guides preventive discussion differently from a diary showing 20 mixed-type headache days with daily analgesic use. The former may benefit from lifestyle modification and targeted preventive; the latter requires medication-overuse screening and structured withdrawal before any preventive is effective. Without a diary, treatment decisions are based on impression rather than evidence.

Practical tips for Kathmandu residents: Monsoon weather changes, irregular meal patterns due to work schedules, late-night screen use and caffeine from chiya are common triggers to note. Traffic-related stress and air quality are worth recording if they correlate with attacks. Track headache alongside sleep and menstrual cycle for a complete picture.

Bring your completed diary to every headache consultation at Durbar Marg, Opposite of Yak & Yeti Hotel. Four to eight weeks of data is ideal. If you have not kept a diary before, start today —— even partial data is better than none.

This article is educational and does not replace individual medical advice.