- Lifestyle changes. This will be important if you are making changes to your diet or routine to try and manage your headache disorder.
- Medication. Any preventive or acute medication taken before or during the attack.
- Relief measures. Using an ice pack, bed rest, relaxation techniques, etc.
- Hormones (for women). You can track your menstrual cycle to see if your attacks are linked to your hormones (i.e. ‘menstrual migraine’). If you think your headache is related to your hormones, you should also track any contraceptive or hormonal medications.
As you can see from this list, a headache diary can be as simple or as detailed as you like. More detailed diaries often make it easier to identify patterns or triggers in your migraine/headache attacks. However, the best diary is the one that works for you. If you are finding it overwhelming, you can start with just a few symptoms or possible triggers, and work up from there. In the early stages of management you might just want to establish the frequency, severity, and one or two possible triggers.
How do headache diaries & migraine diaries improve management?
Diagnosis
Headache disorders can be difficult to diagnose. Sometimes this is because the doctor doesn’t know much about migraine and headache disorders, and other times it could be because you don’t remember certain symptoms or the frequency of attacks. This is completely normal – these disorders are complex, and you might not remember every characteristic off the top of your head. There is also a lot of stigma associated with headache disorders, and you might be used to downplaying the severity or frequency of attacks.
If you are going to speak to your doctor about your headache disorder, you should make an appointment specifically to talk about your headache attacks. It’s important to have a dedicated appointment so that you have time to properly explain your symptoms and explore possible treatments. You can keep a headache diary in the weeks (or ideally, months) leading up to this appointment, to give your doctor a clear overview of how this disorder is affecting you.
Trigger management
This is one of the most significant ongoing roles of a headache diary. It is particularly useful for people living with migraine. While disorders such as cluster headache often only occur for a few weeks each year (i.e. the start of spring), it can be harder to identify triggers for migraine attacks. Common triggers include things such as:
- Stress
- Sleep
- Emotion
- Weather/environment
- Visual
- Hormones
- Food/eating habits (including dehydration)
- Smell/odor
- Alcohol
- Activity/exertion
(Data from Migraine Buddy app users, 2021).
You can track triggers in a few different ways. When you are trying to identify new triggers, you might think of the hours or days preceding an attack, and see if there were any changes that could be a trigger. Diaries can also help you rule out triggers. For example, you can write down every time you have a poor night’s sleep or eat a specific food, and see if it lines up with headache days. In other cases, you might be making changes to your lifestyle to reduce migraine attacks. Once you have made the change, the diary should be able to help you identify if it’s making a difference in headache frequency or severity.
Medication
Headache & migraine diaries can help you identify what type of treatment you need and which medications are effective. If you are taking acute medications, you can start by figuring out which ones are best suited to your symptoms – whether this is an over-the-counter painkiller or something like a triptan. Depending on your symptoms, you might prefer ibuprofen over paracetamol (or vice versa). There are also multiple types of triptans. Some people will respond to one triptan but not another, so this can help you work out which one is best for you.
You can also track how often you are taking medication. Many acute medications (particularly triptans and paracetamol) can cause medication overuse headache if they are used too often. This might seem contradictory, but taking painkillers too often can actually make your headache worse. Simple analgesics (ibuprofen, paracetamol, aspirin) should be limited to 15 days per month, and triptans should be limited to 10 days per month.
If you feel like you need painkillers more frequently than this, you might have a chronic headache disorder (usually defined as 15 or more headache days per month). In this case, a preventive medication is a good option. There are many types of preventive medications, so your headache diary can help you measure the effectiveness of any treatment.
Headache & Migraine Diaries:
Helping Your Doctor Treat Your Headache:
