Chicken livers

Onions

Fresh baked bread, doughnuts, coffee cake

Nuts, figs

Pork

Chocolates

Ripened cheese (Except cottage, American, Velveeta, and cream cheese)

Sour Cream

Herring

Beer

Vinegar (Except white)

Red Wine

Yogurt

Bourbon

Navy & Lima beans, pea pods

Gin

Sausage

Peanut Butter

Hot Dogs

Flavor Enhancers (MSG)

Some lunch meats (Bologna, salami, pepperoni)

Many restaurant dishes

Chinese foods (MSG)

Pizza

Fermented, pickled and marinated foods

Coffee, tea, coke, etc.

Permissible to drink in moderation: Seagram's VO, Vodka, Haute Sauterne Riesling, Cutty Sark

Excedrin (& other caffeine-containing analgesics)

Most citrus fruits / avocado

Spices

Bananas

Date

Time of Day (onset/offset)

Diet (1)

Meds (2)

Severity (3)

Psychological (4) or Physical

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Patients can use this diary form (or a calendar) to clarify the doctor's interview data.

1) DIETARY FACTORS: a) chocolate b) ripened cheeses c) alcoholic beverages d) fresh baked breads e) Chinese foods containing monosodium glutamate f) sausages * cold cuts g) caffeinated beverages h) nuts i) citrus fruits j) figs, beans, onions, bananas, avocados k) herring, vinegar l) fermented foods such as yogurt or sour cream m) pickled or marinated foods n) other

2) MEDICATIONS taken and dosages (for instance, some patients feel eye and/or head pain following use of pilocarpine or phospholine iodine eye drops)

3) SEVERITY, scaled from #1 to #10, where #1 is very mild and where #10 is very severe.

4) PSYCHOLOGICAL OR PHYSICAL FACTORS: a) emotional upset, b) strenuous exercise, c) Physical illness d) menstruation, e) fasting or missing a meal, f) abrupt weather changes such as in temperature, humidity, sunlight, or season, g) work environment (air-conditioning, fumes, etc.) h) over or under-sleeping, i) vacation or weekend j) other