Could a migraine diary be making you feel worse?

Keep a migraine diary.” This has been the most consistent advice among the headache specialists I’ve seen in three corners of the country. Some doctors advise tracking attack frequency and pain levels, others recommend detailed accounts of possible triggers, foods eaten, other symptoms before and during the attack, medications, duration, fluctuation in pain levels, day of menstrual cycle, hair color… I understand the rationale behind the advice and know it is a smart technique. Yet, I don’t keep a migraine diary.

I’ve keep diaries from time to time, a few months here, a couple weeks there. The longest I’ve stuck with one is six months. For most of the 14 years since I was diagnosed with migraine, I didn’t keep a diary because I didn’t want a record of the pain or to see how disabling the other symptoms were. It seemed to serve me well. A day or two after a migraine spike dissipated, I’d forget how severe it had been. When asked how frequent my attacks were, I’d say five days a week. They were actually daily. By not keeping track, I could fool myself into believing the attacks were not as frequent or disabling as they truly were. This complicated tracking my physical health and medication effectiveness, but it was a balm to my mental health.

I may have been onto something. In a study on how keeping a pain diary affected patients’ recovery from acute lower back pain, researchers found that those who kept a pain diary had a “much worse outcome” than those who did not. At the start of the study, all 58 participants had the same level of disability. Half were told to rate their pain on a scale of 1-10 in a daily diary. The other half did not record their pain levels. Among those who kept diaries, 52% reported recovery at the end of three months. In the group that did not keep diaries, 79% reported recover in the same time span.

Lead author Robert Ferrari, MD, believes these findings clearly indicate that asking patients to focus on symptoms can amplify symptoms and that such a focus can create a perception of illness and hinder recovery. He recommends that physicians and therapists avoid asking their patients to keep pain diaries.

This study is not directly applicable to migraine because migraine has more triggers and symptoms than acute back pain. Also, migraine diaries are most useful when they go beyond tracking pain levels and symptoms. With enough detail on things like triggers and premonitory symptoms, they can give you data that can help reduce your migraine frequency and severity. Still, if you feel like your migraine diary is weighing on you and doesn’t help you predict and treat your attacks, maybe a short break would be beneficial.

I continue to bounce back and forth between keeping a diary and not. When I’m trying to track a trigger or see if a new medication is helpful, I keep a diary. When I feel like I have a good grasp on my treatment or am in a rut, I don’t. It’s not an ideal solution and I do occasionally wish I had better data. But I just can’t bring myself to reflect on my degree of disability every single day.

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