Free to print

My headache history, on two pages.

A new neurologist has a few minutes to understand years of headache. Fill this in before the appointment — especially the table of everything you have tried — and hand it over at the start.

Two pages, portrait, A4 or US Letter. Print double-sided if you can.

My headache historyPlease read before the consultation · page 1 of 2

Name Date of birth Filled in on Phone

1. How it started

Date the daily headache started: I remember the exact day: yes roughly no

Around that time I had:

an infection or flu-like illnessCOVID-19surgery or a general anaesthetica head or neck injurya very stressful eventnothing I can identifyother:

It became constant: within 24 hours within days gradually over weeks or longer

Before this I had: no regular headaches occasional headaches migraine other:

2. The headache now

Where it hurts:

Usual pain (0–10): Worst:

It feels: pressing/tight throbbing stabbing burning other:

Has it ever fully stopped since it began? never yes, for

Also:

nausealight hurtsnoise hurtsdizzinessneck painbrain fogfatiguepoor sleepwatering or red eye on one sideblocked nostril on one sidevisual aura

Worse when:

standing or sitting uplying downcoughing or strainingphysical activityscreensstressmy period

3. Warning signs — tick any you have had

sudden “worst ever” headachefever or night sweatsweight lossnew weakness or numbnesstrouble speakingloss or greying of visionwhooshing in the earsstarted after age 50jaw pain when chewingpregnant or recently gave birthcancer or low immunitysteadily getting worse

4. Tests already done

Test	Date	Where	Result
MRI brain (with / without contrast)
CT scan
Venous scan (MRV / CTV)
Lumbar puncture — opening pressure
Blood tests
Eye examination

Free from ndph.org · continue overleafNot a diagnostic tool

Everything I have triedPreventives, acute medicines, injections, blocks, supplements and therapies · page 2 of 2

Name

5. Treatments — one per line, oldest first

Medicine or treatment	Highest dose	Started	Stopped	Helped? none / some / a lot	Side effects · why I stopped

Tip: a preventive usually needs 2–3 months at an adequate dose before it can be called a failure. If you stopped sooner, note why.

6. Painkillers and acute medicines now

Medicine	Days per month	Does it help?

7. Other health information

Other conditions:

Allergies:

Family history of headache:

8. What I most want from this appointment

Free from ndph.org · bring your headache calendar tooNot a diagnostic tool

Why the treatment table matters most

NDPH is one of the most treatment-resistant headache disorders, and many people try a long list of preventives before something helps.^7,40 Without dates and doses, a new specialist cannot tell a medicine that genuinely failed from one that was stopped after two weeks at a low dose — and may suggest it again. Filling in this table is often the most useful thing you can do before an appointment.

Pair it with the year calendar so your doctor can see both the history and the recent pattern.

References

Numbers in the text link to these sources. Where the evidence comes from migraine rather than NDPH, the text says so.

Cheema S, Mehta D, Ray JC, Hutton EJ, Matharu MS. New daily persistent headache: a systematic review and meta-analysis. Cephalalgia 2023;43(5):3331024231168089. doi.org/10.1177/03331024231168089
Yamani N, Olesen J. New daily persistent headache: a systematic review on an enigmatic disorder. J Headache Pain 2019;20:80. doi.org/10.1186/s10194-019-1022-z