A comparison between prospective Internet-based and paper diary recordings of headache among adolescents in the general population

Cephalalgia. 2016 Apr;36(4):335-45. doi: 10.1177/0333102415591506. Epub 2015 Jun 19.


Aim: The aim of this article was to develop and apply an Internet-based headache diary (i-diary) for adolescents and compare it with a paper-diary (p-diary) regarding adherence, user acceptability and recorded headache activity.

Methods: In a cross-sectional school-based study, a representative sample of 488 adolescents aged 12-18 years were randomly allocated by cluster sampling to record for three weeks in i-diaries or p-diaries their headache intensity, disability, and use of acute medication.

Results: A significantly (p = 0.008) higher proportion of adolescents in the i-diary group used the diary at least once during the 21-day period (86% vs 76% for the p-diary). However, the p-diary group completed a significantly (p < 0.001) higher number of diary days (20.8 vs 15.0 days for the i-diary). The response rate for the i-diary-group was largely evenly distributed over the study period; conversely, approximately two-thirds of the adolescents using the p-diary responded on all 21 days, whereas one-fourth did not respond at all. The two diary types were rated as equal in easiness to remember (p = 0.25), but the i-diaries were more bothersome to use (p = 0.029).

Conclusion: Although p-diary users completed a higher proportion of diary days, i-diaries provided more reliable and credible estimates of headache parameters because of better real-time assessment.

Keywords: Electronic diary; Internet; adherence; adolescents; headache; paper diary.

Publication types

  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Female
  • Headache / epidemiology*
  • Humans
  • Internet*
  • Male
  • Medical Records*
  • Patient Compliance / statistics & numerical data
  • Patient Satisfaction / statistics & numerical data
  • Prospective Studies