Keep a Headache Journal to Understand Your Migraine

Experiencing migraine attacks is a real pain. While you may think of them as severe headaches, the biology and treatments of migraine are different. 

A headache may go away after taking a couple of Tylenol, but the moderate to severe throbbing of migraine can persist for days. Figuring out what triggers your migraine episodes may help you better predict, prepare for, and possibly stop some of these debilitating attacks. 

That’s why headache specialists and neurologists recommend that people with migraine track their occurrences in a migraine journal or electronic diary. 

What is a migraine?

“Migraine is an inherited, chronic, multi-phasic brain disorder with environmental factors,” says Teshamae Monteith, M.D., a neurologist and Chief of the Headache Division with the University of Miami Health System. “

They are diagnosed by symptoms of moderate or severe headache, gastrointestinal symptoms and sensory disturbances, including sensitivity to light, sounds, smell and movement. You may experience additional symptoms that impact your cognition or transient changes in vision, speech, strength, sensation and balance, known as migraine aura.”

The pain-free period before you feel a migraine coming on is called the prodromal phase. During this stage, you may experience symptoms like sensitivity to light, fatigue, food cravings, and nausea. 

You may assume that some of these symptoms are triggering your migraine attacks. But, Dr. Monteith says, these are more likely signs that your migraine attack has already begun. 

These early signs can start before the actual head pain begins. “Neck pain is also common during migraine attacks, and their occurrence may sometimes lead to the misdiagnosis of cervicogenic headache or posture as the problem,” she says.

Migraine attacks can be triggered by:

• stress
• hormonal fluctuations
• lack of sleep
• caffeine
• alcohol (especially red wine)
• certain foods (commonly cheese and chocolate)
• certain medications
• changes in weather and sensory stimuli (sounds, lights, smells)

What should you include in your migraine journal?

“The migraine journal is helpful to assess the frequency of migraine or headache days and to possibly identify certain triggers, such as menstruation,” Dr. Monteith says. 

“The journal is an important tool to determine if interventions are helping or not working at all.” There are many forms of journals and calendars, including web- and app-based trackers. “We recommend Migraine Buddy,” she says.

What should I track in a migraine journal?

• date(s) of the headache 
• pain intensity (scale of 1 to 10)
• duration of the headache
• acute medications: dosage taken, when you took it (how long before or after symptom onset)
• effectiveness of medications to relieve symptoms (scale of 1 to 10)

You may also want to track:

• type/description of the pain (such as throbbing, sharp or tender to the touch)
• location of the pain (where on the head and the size of the painful area)
• any other symptoms (like fatigue, sensitivity to light/sound/movement, nausea, lightheadedness) 
• how fast these additional symptoms come on and how long they last
• what you were doing before symptoms began (activities such as eating, running, reading, looking at a screen)
• female menstrual cycle timing (date of your last period or when you expect it will start)
• stress level (scale of 1 to 10)
• quality and duration of last night’s sleep

Why should I keep a migraine journal?

Once you’ve experienced and tracked at least one month’s migraine attacks, you can work with your doctor to analyze your headache journal. This information can help guide your migraine treatment, point to any impact on your function, and identify possible recurring migraine triggers. 

“Migraine attacks may be spontaneous or unavoidable, but if you are able to detect a consistent trigger, it might be worthwhile looking into to avoid those inciting events,” Dr. Monteith says.

If your migraine trigger is unavoidable, simply knowing what it is can enable you to prepare yourself for an oncoming migraine.

The prodromal phase (before your head hurts) is a good time to:

• Try relaxation techniques
• Isolate yourself from bright lights, loud noises and sources of stress
• Avoid activities that tend to worsen your migraine (like reading on a computer screen)

What if avoiding migraine triggers and taking medications aren’t working for you?

Because migraine is most often an inherited condition with environmental factors, “identifiable patterns or triggers are sometimes unknown,” Dr. Monteith says. 

If your current regimen is ineffective, discuss with your doctor the option of changing your medication dosage or timing, taking a different drug, or trying other therapeutic options. “New treatments may help during the prodromal phase, as the attack is approaching.” 

If you experience migraine more than four days per month, or if your attacks are disabling for a few days each month, you may be a good candidate for a preventive approach. This can include both pharmacological and non-pharmacological interventions to help you achieve more headache-free days.

Dana Kantrowitz is a contributor to UHealth’s news service.

Tags: chronic headache, Dr. Teshamae Monteith, headache care in Miami, migraine triggers, stages of a migraine attack, throbbing pain