The appointment is short. Some of it goes on the examination, some on history you have given before, and some on the logistics of getting you out of the room with a plan. The part where your own account actually shapes the decision is a few minutes long.
These are ways to make those minutes count. None of it is medical advice — it is about how to present what you already know.
Lead with the three numbers
Headache days per month, typical duration, treatment days per month. Said first, in one sentence, before anything else. Something like:
“Over the last three months I have averaged nine headache days a month, they run about eighteen hours untreated, and I am taking something on six or seven days.”
That sentence does more work than ten minutes of description, because those are the figures the next decision turns on. Everything else — the quality of the pain, the aura, what makes it worse — lands better once the frequency is established.
Bring one page, not thirty
Nobody is going to read eight weeks of daily entries during your appointment. Bring the summary: the three numbers, the trend, and at most two or three observations you think are real. Keep the full record available in case you are asked.
If you are bringing a printout, bring a spare. If you are bringing a phone, know where the screen is before you sit down.
Be specific about what you have tried
“I tried that one, it did not work” is the answer that costs the most time, because it leads to a set of follow-up questions that have to be asked. Have the answers ready:
- What it was, and the dose.
- How long you took it for.
- How you took it — for a preventive, whether you got to a full trial period; for an acute treatment, how early in the attack you took it.
- Why you stopped: no effect, side effects, cost, ran out, forgot.
“Did not work” and “stopped after four days because it made me feel awful” are very different pieces of information, and only one of them tells you anything about whether the treatment would have helped.
Say the alarming things first, not last
If anything about your headaches has changed — a new pattern, a sudden severe one unlike the others, a headache after a head injury, one with fever or a stiff neck, or new weakness, numbness, confusion or trouble speaking — lead with that. Do not save it for the end, and do not wait for an appointment if it is happening now: that list is emergency territory, and the answer is 911 or an emergency department rather than a diary entry.
Three questions worth the time
- “Given these numbers, are we in acute-treatment territory or preventive territory?” It names the actual fork in the road and makes the reasoning explicit.
- “How long should I give this before we decide it is not working, and what should I be recording in the meantime?” Prevents the common failure where something is abandoned before it has had a fair trial, or continued long after.
- “What would make you want to see me sooner?” Turns a vague “come back if it gets worse” into a threshold you can actually apply.
Afterwards
Write down what was decided while you still remember it — what you are taking, at what dose, for how long, and what you are meant to be watching for. Then keep recording exactly as before. The point of a consistent diary is that the months either side of a change are comparable; changing what you track at the same time as changing the treatment throws away the comparison you were keeping the diary for.
Sources
- Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia 2018;38(1):1–211. ichd-3.org
Written in house and checked against the ICHD-3. Where this page describes the state of the evidence rather than a specific finding, it says so, and it cites nothing it cannot point at. A named clinical reviewer is to be appointed before launch. Found an error? Tell us and we will correct it on the page.
