Month/Date ee _your MONTHLY Name. _ IGRAINE DIARY Use this diary to develop a general overview of your migraines from one month to the next. Bring your diary with you to all your doctor appointments to discuss progress and treatment goals. Instructions: 1, For every day of each month that you experience a migraine, enter "M"in the appropriate box. 2. you experience another type of headache, enter "Hin the appropriate box. 3, Record the pain severity forall headaches using an 11-point scale, where 0 = no pain and 10 = the worst pain you have experianced. 4. Ifyou treat your headache pain with medication, please mark "" in the medication row. You may lst the madication taken and the dose below. 5. Enter *P* on the first day of your period (ff applicable), My medications au a——_ Month/Date. _ MONTHLY MANAGEMENT DIARY Category: HA score = headache score ( M = Migraine Marian H = Other headache P = Period fif applicable) ‘no pain; 10 = the worst pain you have experienced) "forall days you take medication, Cont creas eo fred ‘Maaieation Ce ed Modicstion 1 a 2PTsT EP [el fel [e[slsleln[e]efe psa ]e =]*[a[@le[a Coe aE fel re ize | Maicaton I | Month _ 2[TeTs[e ls [e]e]e[s]ela|«[e[=|o]e[uls|[olalal=|eleTo ea fod L Adapted from the American Headache Society. SS ALLERCAN ©2011 Atergan nc. vine, 0892612 wmwrMyChronteMigraine.com APOBIUMI! 11359