Kim’s Journal Form to log daily health information and observations of various conditions. DateDate of the entry MM slash DD slash YYYY Do any of these apply today?Please choose the most significant from this list.None of these applyStress – Emotional stress, anxiety, lack of sleepSleep – Too little or too much sleep, irregular sleep patternsDiet – Skipped meals, dehydration, caffeine, alcohol, certain foods (e.g., aged cheese, MSG, chocolate)Environmental – Bright lights, flashing lights, loud noises, strong smells, weather changes (especially barometric pressure)Physical – Fatigue, overexertion, poor posture, injuryHormonal – Menstrual cycle, menopause, hormonal medicationsMedication / Substances – Caffeine withdrawal, side effects of prescriptions, recreational drugs, alcoholSensory Overload – Crowded places, busy environments, visual or sound stimuliScreen Time – Long exposure to computers or phones, eye strainInfection/Illness – Fever, flu, infections, chronic conditions flaring upMovement Related – Sudden movements, bending over, head turning, walking long distancesMigraine Yes No Migraine Duration (mins)Duration of migraine in minutesMigraine Intensity1 – Very mild – barely noticeable | No interference with activities2 – Mild – noticeable but easy to ignore | Minor inconvenience3 – Mild–moderate – present but manageable | Slight effect on focus or comfort4 – Moderate – distracting, occasional interference | Some tasks more difficult5 – Moderate–strong – clearly affects you | Must pause or adjust activity6 – Strong – frequent discomfort or difficulty | Limits daily function at times7 – Severe – hard to ignore, significant interference | Daily activities often disrupted8 – Very severe – intense or persistent | Requires rest, medication, or help9 – Extreme – unbearable at times | Unable to do normal activities10 – Worst imaginable – overwhelming | Emergency or hospital-level concernMigraine TriggerMigraine MedicationsIE: Sumatriptan, Excedrin, AsprinDizziness/Balance Issues Yes No Weakness (specify area)Numbness / TinglingTremors / Involuntary MovementsSpeech / Language ChangesMemory / Concentration IssuesSleep ChangesMood/Personality ChangesPain (burning/shooting etc.)Exercise Yes No Exercise TypeGait/Walking Changes Yes No Vision Changes (blurry/double/loss)Bowel/Bladder IssuesNausea/Vomiting Yes No Sensory Sensitivities (light/sound)Muscle Spasms Yes No Electric-Shock Sensations Yes No Hot Flashes Yes No More than 2? Yes No NotesAny additional notes. Spreadsheet Draft Entries
