What to write in a migraine diary

Why doctors ask you to keep one

Migraine is diagnosed mostly from your own account of your headaches. The US National Institute of Neurological Disorders and Stroke (NINDS) notes that scans such as MRI or CT are not usually used to diagnose migraine; a doctor asks when headaches start, how long they last, what they feel like, what triggers them and what other symptoms come with them. A diary answers those questions from records instead of memory, which is why the UK's NICE guideline on headaches tells clinicians to consider one to aid diagnosis.

Memory is a poor counter. The American Migraine Foundation (AMF) says many people underestimate how many days they have a headache, because they count the really bad days and discount the not-so-bad ones. The International Headache Society's classification, ICHD-3, makes the same point from the doctor's side: characterising frequently recurring headache generally requires a diary that records pain and associated symptoms day by day for at least one month.

The Migraine Trust, a UK charity, sums up what a diary is for: helping your doctor make a diagnosis, recognising triggers and warning signs, checking whether acute or preventive medication is working, and showing patterns.

The basics to record for every headache

NICE gives a short list for anyone asked to keep a diary for a minimum of eight weeks: the frequency, duration and severity of headaches; any associated symptoms; all prescribed and over-the-counter medicines taken to relieve headaches; possible precipitants; and the relationship of headaches to menstruation. Everything below fits inside that list.

When it started and when it ended. Write the time, not just the date. The NHS says migraine attacks usually last between 4 hours and 3 days, so a single entry can run into a second day. ICHD-3 has a rule for a common case: if you fall asleep during an attack and wake up without it, the attack counts as lasting until the time you woke.

How bad it was. The Migraine Trust suggests recording severity as mild, moderate or severe, or on a scale from 1 to 10 where 10 is the worst pain you can imagine. The AMF suggests using a 0 to 10 pain scale when you describe your pain to your doctor. Pick one scale and keep using it, so this month can be compared with last month.

Where it hurt and what it felt like. The AMF recommends noting the location, intensity and quality of the pain: one side or both, throbbing or pressing. It adds that a migraine attack often feels like a throbbing pain or a pounding sensation.

Other symptoms and aura

Head pain is only part of an attack. The AMF suggests recording associated symptoms such as aura, nausea, vomiting and sensitivity to light and sound. The Migraine Trust adds dizziness, vertigo, sensitivity to smells and any symptoms that affect your movement, such as numbness.

If you get aura, note what it was and how long it lasted. The NHS describes aura as warning signs such as problems with your sight, like zigzag lines or flashing lights, numbness or tingling, feeling dizzy or difficulty speaking, and says aura symptoms should not last longer than 1 hour. NINDS says auras appear about 10 minutes to an hour before the attack and usually last no more than an hour. The NHS advises asking for an urgent GP appointment, or using NHS 111, if aura symptoms last longer than an hour at a time.

Medicines: what, when, and whether it helped

NICE asks for all prescribed and over-the-counter medicines taken to relieve headaches, so the bottle of ibuprofen in your bag counts as much as a prescription. Write the name, the dose and the time. The Migraine Trust specifically mentions recording whether you took a second dose, and any side effects.

Then note whether it helped. The AMF advises bringing your doctor a list of every medication or treatment you have tried, how you responded and any side effects, including the dosage and how long you tried it.

It is also worth being able to count the days on which you took something. NICE tells clinicians to be alert to medication overuse headache in people whose headaches developed or worsened while taking triptans, opioids, ergots or combination painkillers on 10 or more days a month, or paracetamol, aspirin or an NSAID on 15 or more days a month, for 3 months or more. Your diary does not need to interpret that number. It only needs to make the count possible.

Possible triggers, sleep and your cycle

NINDS suggests writing down, after each headache, the time of day, how intense it was and how long it lasted, any sensitivity to light, smells or sound, any activity right before it started, any medicines taken, the quality and length of the previous night's sleep, any stress or strong emotions, the weather or changes in your daily routine, food and drinks in the previous 24 hours, and any other health conditions. You do not have to log all of it every time.

If you have periods, record the days. NICE says to suspect menstrual-related migraine if migraine occurs predominantly between 2 days before and 3 days after the start of menstruation in at least 2 out of 3 consecutive cycles, and to confirm it with a headache diary covering at least 2 cycles. The AMF says that among women with migraine, about two-thirds have menstrually related migraine.

Treat triggers as suspects, not verdicts. In an AMF interview, headache specialist Dr. Ira Turner warns that not everybody has reproducible, consistent triggers, and that what people think are triggers are not always actually triggers. The AMF also notes that what looks like a food trigger can be a craving that is part of the early, prodrome phase of an attack.

Common migraine diary mistakes

Only logging the bad days. This is the AMF's main warning: if you report only your most severe headaches, your doctor gets a false picture of how often you have them. A mild headache day is still a headache day.

Writing a novel, then giving up. Dr. Turner's advice, quoted by the AMF, is to keep a calendar and make an entry on the days you get a headache, adding as much detail as you can without getting to the point where you are writing a book. The Migraine Trust also says it is often best to keep it simple.

Stopping too soon. NICE asks for a minimum of eight weeks, the AMF suggests one to two months to look for patterns, and a menstrual pattern needs at least two cycles.

Bringing a stack nobody can read. The AMF says a journal is only useful if your doctor can review it quickly and understand it clearly. If you would rather not total a paper diary by hand, MigrainePage records the start and end of each attack, its peak pain, medicines and whether they helped, and the triggers you suspect, then turns the last three months into a one-page summary with headache days and medicine days for each month.

This guide is general information, not medical advice, and a diary does not diagnose anything. The NHS advises calling 999 for a headache that comes on suddenly and is extremely painful, or for symptoms such as weakness on one side of the body, problems speaking, or loss of vision. For anything else that worries you, talk to your doctor.

Frequently asked questions