Many therapeutic decisions in the management of migraine patients are based on patient recall of response to treatment. McKenzie and Cutrer compared patient recall of migraine headache frequency and severity, as reported in an interval questionnaire versus a daily diary, over four weeks prior to a return visit. As consistent completion of a daily headache diary is problematic, the investigators assessed the reliability of patient recall in a one-time questionnaire. Headache frequency and average severity (0 to 3-point scale) were reported in an interval questionnaire by 209 patients who had also maintained a daily diary over the same four-week period. Results indicated that headache frequency over the previous our weeks as reported in interval questionnaires (14.7) was not different from that documented in diaries (15.1). However, reported average headache severity on a 0 to 3 scale as reported in the questionnaire (1.84) was significantly worse than that documented in the diaries (1.63).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The authors concluded that in the management of individual patients, the daily diary is still preferable when available. Aggregate assessment of headache frequency in groups of patients based on recall of the prior four weeks is equally as reliable as a diary. However, headache severity reported in questionnaires tends to be greater than that documented in daily diaries and may be less reliable.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The effectiveness of any self-management efforts rests on the self-monitoring conducted by patients. Thus, if you are tracking the number and severity of headaches you experience, you should consider using a daily diary over a questionnaire completed on a periodic or aperiodic basis. Overall, daily self-monitoring provides you with a more complete record of both your condition and the actions you take with regards to the management of a chronic illness.

JA McKenzie, FM Cutrer. How well do headache patients remember? A comparison of self-report measures of headache frequency and severity in patients with migraine. Headache, 2009;49:669-672.