Log each cluster headache attack separately, then make a second note about your mood when the attack pain has stopped. Date and time both records so your neurologist can distinguish distress during pain from how you feel in the hours between attacks. A short record can support the conversation; it cannot diagnose depression or tell you to change treatment.
Use this method for an upcoming neurology or headache appointment, whether you already have a diagnosis or are being assessed. If your clinic supplies a diary, keep using it and add the separate mood note alongside it. Do not wait to complete a log before seeking care for a new or changing headache.
Two clocks make the record clearer
The attack clock describes what happened during one episode of pain. The between-attack clock describes a later moment, after that attack has ended and before another begins. A pain-free interval does not necessarily mean that tiredness, worry or other difficulties have disappeared.
For example, “pain stopped at 02:30” and “at 08:00 I felt low and missed work” answer different questions. Write both times rather than compressing them into “bad day.” Research on the burden between cluster headache attacks supports paying attention to those hours, although it does not validate this particular logging format or a depression score.
What goes on the attack line
Start with the attack date, start and end times, pain location and intensity. Add whether it woke you, whether you were restless, other symptoms, what you used and any relief you noticed. These are observation fields drawn from ordinary headache-diary practice, not a checklist that confirms cluster headache.
Write the entry after the attack if that is more manageable. Label recalled times “approximately,” and leave a field unknown when you cannot remember it. The headache-diary section of Mayo Clinic’s appointment guidance provides a useful reference for the core attack details.
What goes on the between-attack line
Record the observation date and time, whether attack pain is still present, estimated sleep hours, your mood in your own words and one effect on daily life. “Worried about tonight; cancelled dinner” is more informative than a number alone. If pain is ongoing, say so and keep the observation separate rather than labeling it pain-free.
You may add a personal low-mood rating from 0 to 10, with 0 meaning no low mood and 10 the most intense low mood you can describe. Use the same meaning each time, and leave it blank if the number does not help. It is an unvalidated personal shorthand, not a PHQ-9, depression diagnosis, risk assessment or treatment threshold.
| Record | Useful detail | What it cannot establish |
|---|---|---|
| One attack | Date, start/end, side, pain rating, waking, restlessness, symptoms, what was used and relief. | The diagnosis or the best treatment. |
| One later mood observation | Its own timestamp, pain status, mood wording, optional low-mood rating, sleep and missed plans. | Whether depression is present or why mood changed. |
| A day without a recorded attack | Write “no attacks observed” only if you know; keep a later mood observation if useful. | That an empty row means an attack-free day. |
| A gap in the record | Write “not recorded” and resume at the next manageable moment. | That nothing happened during the gap. |
A week that was too detailed to finish
The example below is invented to demonstrate the method; it is not a patient account or evidence of typical attack frequency. The first version asked for too much during pain: hourly mood scores, every food ingredient and a complete explanation of the trigger. The revised version kept attack times, a few symptoms and one later observation, with unknowns left visible.
On Monday night, the illustrative record has three attacks: 00:40–01:15, 02:00–02:30 and 04:10–04:45. Each would have its own attack line, even though the seven-day table groups them to make the example readable. The 08:00 observation belongs to Monday morning after those attacks; the reader has described low mood separately from the pain ratings.
| Day | Attack record | Later mood and daily-life note |
|---|---|---|
| Monday | Three separate entries: 00:40–01:15, 02:00–02:30, 04:10–04:45. Left side; pain 9/10; waking and pacing noted. | 08:00, attack pain stopped. Low mood 6/10; sleep about 3 hours; missed work. |
| Tuesday | One entry: 01:20–02:00. Left side; pain 8/10. Treatment and relief recorded on the individual line. | 09:00, no attack pain. Low mood 3/10; sleep about 5 hours; worked a shorter day. |
| Wednesday | No attacks observed; explicitly recorded. | 18:00, no attack pain. Low mood 4/10; sleep about 6 hours; worried about the next night. |
| Thursday | One entry: 03:10–03:50. Left side; pain 9/10; woke from sleep. | 10:00, no attack pain. Low mood 2/10; sleep about 4 hours; kept afternoon plans. |
| Friday | Not recorded. | Not recorded. The blank is a gap, not a zero. |
| Saturday | No attacks observed; explicitly recorded. | 17:30, no attack pain. Low mood 2/10; sleep about 7 hours; usual routine. |
| Sunday | One entry: start approximately 02:00; end unknown. Left side; intensity not recorded. | 09:30, no attack pain. Low mood not rated; sleep unknown; felt drained and postponed errands. |
Thursday shows why the two records should remain separate: severe pain was followed by a relatively low personal low-mood rating. Wednesday shows another possibility: an attack-free day still carried worry. Neither observation proves or rules out depression, and this illustrative week should not become a comparison standard for your own record.
Bout dates belong in the header
Add the date the current run of attacks began, if known, and the date of the most recent attack. Update “most recent attack” as needed rather than deciding that the bout has ended after one quiet day. If you continue observing after attacks stop, label those notes as a later period so they are not mixed with the active-attack days.
Episodic and chronic cluster headache are clinical classifications involving attack periods and remission over time. A week of entries and a mood rating cannot assign either label. Give the clinician your dates and any longer history; let them interpret the pattern.
Sleep, alcohol and restlessness are observations
Record what happened without turning the entry into a causal verdict. “Slept about four hours” describes the night; it does not establish whether sleep disruption preceded or followed the attacks. If sleep problems are also part of your wider mood concerns, keep those questions alongside the separate guide to depression and sleep problems.
Alcohol can provoke attacks during a cluster period, but one diary entry cannot prove the cause of a particular episode. Record exposure if relevant and follow the advice you have already received; do not deliberately test a suspected trigger for the sake of the log. “Noted, not proven” is a useful heading for anything whose relationship to the attack is uncertain.
Restlessness or pacing belongs on the attack line when it occurred during pain. Do not automatically count it as depression, anxiety between attacks or a separate mood score. If a similar feeling occurs later, describe it again with its own time and context.
Build your appointment snapshot
Between-Attack Visit Studio keeps individual attack entries apart from mood observations and prepares a concise seven-day snapshot. Choose the start of the week you want to discuss, enter only what you know and export the full records before closing the page. The A4 page is a summary of that selected week; it does not replace the complete exported log or your medication list.
Between-Attack
Visit Studio
Separate the pain record from the hours afterwards.
Two records One visit snapshotA personal record, not a diagnosis, depression screen or treatment recommendation. For new or changing symptoms, seek care; do not wait to finish a log. For self-harm thoughts, seek immediate support; US: call/text 988, emergency 911; elsewhere use local services.
Entries stay in this page’s memory. This experience does not upload notes or save them automatically. Export before closing or refreshing; exported files contain your private health notes.
Loading interactive controls… If they remain unavailable, use two paper records: one per attack and one separately timed mood note.
Start with any details you know.
Selected week
Counts describe entries, not diagnosis or severity. Multiple mood observations remain separate. A4 groups them by day; export preserves every field.
All entries
Five lines to read at the visit
A short spoken summary helps you identify the questions you want answered. Keep the individual entries available so the clinician can ask about an unusual night or a gap. Do not smooth missing information into a complete story merely to make the summary sound tidy.
- “The current run began around [date]; the most recent attack was [date].”
- “During the recorded week I noted [count] attacks; these days were not recorded.”
- “My later mood notes were made at [times], with attack pain stopped or still present as marked.”
- “Sleep and daily life were affected in these ways: [brief examples].”
- “I would like to ask about the headaches and whether my mood difficulties need a separate assessment.”
Keep different appointment records distinct
If eating has changed as well, describe it on a separate record rather than adding more fields to every attack line. The site’s pages on depression and not eating and anxiety and appetite loss address those different concerns. They do not explain the cause of your headaches or replace assessment of the new symptom.
When to stop logging and get help
Seek prompt medical advice for a headache that is new, different from your usual pattern or becoming harder to manage. Seek emergency care for a sudden extremely severe headache or a headache with new weakness, confusion, trouble speaking or other serious neurological changes. The NHS headache guidance describes warning signs; the record must never delay care.
Thoughts of self-harm need support now, even if you think they occur only during attacks. If you may act on them or cannot stay safe, contact local emergency services or go to an emergency department. In the United States, call or text 988 for crisis support and call 911 for an immediate life-threatening emergency; elsewhere use the appropriate local crisis and emergency services.
Frequently asked questions
What should a cluster headache diary include?
Record each attack’s date, times, pain location, intensity, symptoms, what you used and any relief. Add a separately timed mood observation if you want to discuss the hours between attacks. Use your clinic’s diary when one is supplied and leave unknown details marked as unknown.
Should I log mood only on attack days?
You can make observations on days with no attacks too. State whether you observed no attacks or simply did not record them, because those are different. Keep observations made after a bout separate from entries made while attacks are continuing.
Does feeling desperate during an attack mean I have depression?
A feeling during severe pain cannot establish a depression diagnosis. Describe when it happened and whether it continued after the attack, and ask a clinician to assess the concern. If the feeling includes self-harm thoughts, seek support now instead of waiting for a diary review.
How long should I log before a neurology visit?
Ask the clinic whether it wants a particular length or format. Start with the time you have and bring incomplete entries rather than postponing care to produce a perfect week or month. Seven days here is an example and a print-summary window, not a clinically validated minimum.
What if writing during an attack is impossible?
Write afterwards when you are able, or ask someone you trust to note the times with your agreement. Mark an estimate as approximate and avoid inventing a precise time. A brief entry with honest gaps is usable for conversation.
When is low mood a reason to seek urgent help?
Seek immediate support for self-harm thoughts or an inability to stay safe, regardless of any personal mood rating. Contact emergency services for imminent danger and a crisis service for immediate support. Persistent or troubling low mood also deserves clinical attention without waiting for the log to be complete.
Your next step
Choose the least demanding record you can keep and start with the next observation you can make safely. Bring the dates, the separate attack and mood entries, your current medication list and the questions you want answered. The aim is to make the appointment conversation clearer, not to judge how well you coped with the week.
