Managing Migraine

Patients Migraine Diaries

The keeping of a migraine diary by a patient for three months is a useful diagnostic tool for a health professional in primary care, especially if making a diagnosis is not clear or if the patient has more than one type of headache. A migraine diary is also useful if there is either medication overuse or medication misuse.

A patient should be asked to keep a migraine diary on a daily basis and that they record all of their symptoms and migraine or headache treatments taken. They should record the time and the dosage of any medication and whether there were any side effects. Whether there was any sickness or vomiting along with the severity of the attack on a scale of 1-10 (10 being severe) may also be recorded. A diary also enables the patient to record activities or events such as weather, work, stress, social activity, bowel movement, menstrual cycle, drugs, food and drink which may be migraine triggers.

If the diary shows there is a pattern of episodic headaches punctuated by periods of being free from headache then the patient most likely has migraine.

Whilst using a migraine diary can take several months it is likely that the GP or community nurse already knows the patient and so some of the questions required for the diary may already be known. A fundoscopy and a blood pressure examination is required but an extensive examination of the patient is probably not necessary.

If there is any doubt concerning diagnosis the use of a migraine diary can be very helpful. Because different migraine sufferers respond to different medications and different dosages any diagnosis should be reviewed during follow up visits. A diary can also help evidence coexisting headaches e.g. chronic migraine and medication overuse headache.

The Migraine Trust has an online migraine diary on its website or a paper based version can be ordered from its shop.

Recording details of your migraine attacks can be useful in:

• helping the doctor make a firm diagnosis;
• recognising the warning signs of an attack;
• identifying what triggers your attacks;
• assessing if your acute or preventative medication is working.

The records may include information on:

• when the head pains started;
• how often they happen;
• if there are other symptoms (such as being sick or having vision problems);
• how long the attacks last;
• where the pain is;
• whether the pain is throbbing, piercing;

It is helpful to record as many aspects of daily life as possible, such as:

• what and when you eat;
• your medication;
• vitamins or health products;
• any exercise you take;
• how much sleep you have;
• other factors such as the weather;

Women should record details of their menstrual cycle. It is often useful noting if you did anything different prior to the attack. The 6-8 hours before the migraine attack are particularly important to record.

Monthly Diary

By keeping this diary over a period of 2 or 3 months you may see a pattern to your migraines and headaches. The effect of different aspects of your lifestyle on your migraine may also become clear, and you may identify new triggers.

Migraine Attack Record

This is useful if you want to keep more detailed information about each attack you have. You can use this in conjunction with the monthly record to give more detailed information about each migraine attack.

Record of Drugs

With any drug treatment you should keep a record of the drugs you are taking. This will give you an idea about the type of drugs that work best for you.

Theses diaries are available for download from out fact sheets page.  You can also encourage your patient to use the Online Migraine diary on this site.