Printable template · Free
Headache Diary Template
A one-page monthly headache diary. Record each headache day: your own pain rating, when it started, how long it lasted, and anything you noticed. Bring the printed page to your appointment — a written record is often easier to review than memory.
Tip: choose “Save as PDF” in the print dialog to keep a digital copy. Nothing you do on this page is uploaded — printing happens entirely on your device.
Headache Diary — Monthly Record
Month: ____________ Year: ______ · Mark one row per day. Use the pain legend to shade your rating.
| Day | Pain level 1–5 (shade one) | Time started | How long | Medication taken | Notes (sleep, stress, food, weather… anything you noticed) |
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Headache Diary Printables · free printable headache diary · more templates at https://headache-diary-printables.com
This template is for personal record-keeping only. It is not medical advice and does not replace consultation with a healthcare professional.
How people use this template
- Fill it in at the same time each evening — end-of-day recall is usually more complete.
- Write down what you noticed around the headache, not what you think caused it. Notes like “slept 5h” or “skipped lunch” are records; causes are for you and your doctor to discuss.
- After a month, count the shaded days and look at which notes repeat. Repeated patterns are worth mentioning at your next appointment.
- The boxes are deliberately compact so the whole month fits on one page. If a note doesn’t fit, write it on the back of the sheet and mark the row number (“see back, row 14”).