To Calendar, or Not to Calendar...
That is the question! And the focus of today’s blog post. In the past several weeks, I have noticed more posts, articles and videos recommending against keeping a calendar after years of being told that it is best to do so.
As with everything in this life, everything in moderation and take advice (including mine) with a grain of salt. In my experience, swinging the pendulum from one extreme (keeping track of EVERYTHING) to another (keeping track of almost NOTHING) is not helpful for the patient or the provider. In one, it is too time consuming and there are too many details to find a pattern. In the other, there are not enough details to help with tracking.
Why? Studies have shown that patients report their most recent experience at follow up appointments (whether good or bad), and may not be accurately conveying headache burden. The idea is to find something that is easy enough, but with details to help you and your provider objectively track what is happening.
So, what it boils down to is YOU. What kind of tracking system makes sense for your lifestyle, personality and your headache type and symptoms? As a physician, I am happy to look at whatever recording method you bring to my office. I’ve added a few examples below with patient permission.
At minimum, headache frequency is helpful. If someone is writing headache intensity on a scale from 0-10 out of 10 for the day, then by default that will help track frequency of headache. I recommend using a month calendar, so it is easy to look over (see example below, used with patient permission). Many female patients opt to use their cycle calendar for simplicity. If you have multiple headache types, writing which type of headache can also be used to tailor therapy. I’ve found that some patients write down which medications they used, and by default know which type of headache they were treating. This can be helpful to make sure that symptomatic medications are tracked and not used more than 2-3 days per week. Some people have continuous headache, and prefer to log several times per day. Others have considerable associated symptoms, and will jot down what they were experiencing. In general, if the information will not fit into a square on the month calendar, then you may want to consider simplifying the tracking paradigm.
An alternative simple method, is to write down the dates on the notes in your phone or journal. Others like the statistical functions of applications like migrainebuddy or iheadache, and use headache specific calendars. The downside is that they can be cumbersome, especially mid-headache.
When we have pain, the last thing we want to do is think about it. However, it can be fruitful to track headache frequency, intensity and character for a short time or while making changes to treatment (until at steady state with headache burden) for many reasons. It can help ensure that the patient and provider are on the same page about diagnosis, it may reveal patterns that were not previously thought of and can objectively track headache burden so that discussions can be had about whether treatment changes need to be considered.
The length of time depends on the treatment goals, once changes in medications are no longer being pursued it may not be as helpful to keep track of headaches. Beyond a few weeks to months of tracking headache symptoms if logging is still necessary for treatment, especially for those with refractory headache, focusing on headache free days might be an alternative approach.