Two weeks of a diary beats any scan you can bring us.

THE MOST USEFUL THING YOU CAN CARRY IN

Bring a two-week headache diary and a list of every preventive you have tried, with the dose, how long you stayed on it and why you stopped. If you have them, add imaging reports, prior clinic letters and a current medication list.

Two weeks of a diary is worth more than any scan you can bring us, because it answers the two questions that decide the treatment and no imaging study can answer either one.

What should I write in a headache diary?

• The date, and whether there was head pain at all that day — including days you medicated early and it did not fully develop.
• Roughly how bad, in three levels rather than out of ten. Mild, interfered with the day, could not function.
• What you took, and how many doses.
• Sleep — roughly when you went to bed and got up, not hours slept.
• Anything unusual the day before, including a missed meal, a long drive, alcohol, or a shift change.

That is all. Fifteen seconds a day. The reason it beats a scan is that the two counts it produces — headache days and medication days — are the two numbers every treatment fork in headache care turns on, and both are systematically misremembered. People undercount headache days by excluding the ones they treated successfully, and undercount medication days by thinking in terms of bad days rather than dosing days.

Why bring a list of every preventive you have tried?

Because the dose, how long you stayed on it and what made you stop decide whether a preventive actually failed, and that matters more than most people expect. A preventive stopped after two weeks because of nausea is an incomplete trial, not a failure, and it may well be worth revisiting with a different titration. A preventive taken at an adequate dose for three months with no effect is a genuine failure and closes that option.

Clinics routinely record both as “failed,” and the result is a patient told they have exhausted a class they have barely tried.

And, if you have them

• Any imaging, on a disc or in a patient portal — the report as well as the images.
• Prior clinic letters, especially any that name a diagnosis.
• A current medication list including anything over the counter, supplements and hormonal contraception.
• Your blood pressure readings if you have been asked to record them.

Why do you ask about my week, not just my headaches?

Because attack frequency tracks how much change the brain has to absorb, and most of that change is scheduling. Two biological drivers set the sensitivity — unstable blood glucose widening the swings, and metabolic inflammation lowering the threshold at which a swing becomes an attack. The third is your actual week: shift rotation, meals skipped because a shift did not allow one, sleep that moves several hours on weekends.

A plan that ignores the third one does not survive a working month, which is why the behavioral part of the protocol is delivered in-house rather than handed over as a leaflet.

Questions about preparing

What if I only have a few days of diary?

Bring what you have. Even a week is more useful than memory, and we can start the two counts from it. Why the counts matter.

Should I stop my medication before the appointment?

No. Do not change anything before you are seen — we need to see the actual pattern, and abrupt stops can make things considerably worse. If overuse is part of the picture, unwinding it is done deliberately and with cover: how that works.

Do I need a scan before coming?

No, and for most recurring headache one is not indicated at all. When imaging is appropriate.

Do I need a referral?

No. You can book directly.

What happens at my first headache appointment?

The history and the examination are the workup. We go through your diary to get the two counts, headache days and medication days, review every preventive you have tried and why you stopped, and ask about your week: shifts, skipped meals and sleep that moves on weekends. Records make that faster. They do not replace it.

What if I do not have any records to bring?

Come anyway. The history and the examination are the workup, and the paperwork only makes them faster. If you can, start a diary today: note each day whether you had head pain, roughly how bad it was and what you took. Even a week of that is more useful than memory.

Should I bring my MRI or CT scan to a headache appointment?

Yes, if you have one. Bring the report as well as the images, on a disc or through a patient portal. Just know that two weeks of a diary is worth more than any scan, because no scan can tell us how many days you have headaches or how many days you take medication, and those two numbers decide the treatment.

While you are counting

• How many days did you lose last month?
• What happens at a headache clinic
• When the medication stopped lasting
• Do I need a scan?
• Headache clinic in St. Louis
• Connect with us