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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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

  • Ld5townsend
    1 year ago

    I have a migraine tracking app that I (surprisingly) have used. It said that recording everything while it is happening gave better records than trying to remember later (true) or forgetting altogether (also true). One good thing the app does is tell me how many days I have been migraine free.
    After reading this article and some of the comments, I think I would rather focus on days I don’t have a migraine. I know my triggers, and have meds on hand to take right away. If I note how I feel and what is going on that day, I may find non-migraine “triggers” that I can replicate. Sounds like a worthy project.

  • Crystalrz4
    3 years ago

    I have had migraines for 59yrs. However, in the early eighties, my neurologist wanted me to start keeping a migraine diary. Since then, all of my neuro’s & family practice docs have wanted me to keep them. This is one of the very hardest things I’ve done. Due to the fact that there are so many treatments that I can’t use, one of my most used methods in my tool kit, for dealing with my migraines, is distraction. I have many health problems and sensitivities that limit what I can do for relief. I have two medications, and two OTC’s (limited use) and nothing else.
    In order to keep a log and “Describe” what is going on, i.e., the pain level, what areas it’s affecting, and how it’s affecting them, is almost impossible. It brings my full attention to everything that I’m going through. My pain relief medicines are only somewhat effective and I turn to my other options for help. I have been using distraction so long I have several different ways that I can use it. However, shutting all that down and purposely concentrating/narrow focusing on the pain is the worst thing I can do. I keep a day at a time log, the days date, times and what medication/s I used-if any, what areas of my head are effected and how, and what is going on in the rest of my body (due to my other health problems). It never fails that whatever level my migraines are at, when I’m notating this info, they immediately shoot up much higher. I don’t keep track of what I’ve eaten or drank-I’ve been at this too long and know my triggers. Due to some of my more severe health issues, I know what my physical limitations are –strokes will do that for you. However, my docs still treat me like I have no idea what is going on with me. I actually know my personal medical information far better than they do, and I’ve seen the insides of Emergency Rooms and Hospitals far too many times, that I’d much rather avoid them.

    If you are new to migraines, or early on into them, then keeping a diary is a great tool for both you and your doctor. You do learn so much about what is going on with you and so does you doc. However, if you are experienced with them and you understand your migraines as well as is possible, and your triggers, then the only reason I can see for keeping them is to familiarize a new doctor with your case. At least this is my feeling toward the subject. Everyone has to find their own way with this disease.

  • daisylind
    4 years ago

    I completely empathize with this article. I’ve had migraines for almost 20 years now (jeez), and I’ve tried to keep diaries of different forms on and off. However, it just doesn’t stick. It’s depressing to look back and think you only had X number of migraines, and realize it’s actually double that. I’ve tried iphone apps, but the sheer amount of info they want you to input is literally the last thing you want to do when you’re having a migraine, and afterwards, you’re too exhausted to even remember to do it. My husband says I forget how bad or how severe my migraines are, but I also agree it’s my brain’s way of coping with it.

    Ideally I wish there was a way to log them simply and easily, and just have it go directly to your doctor.

  • BchBm
    4 years ago

    I’ve fought bitterly over this point with my neuro. Most of his chronic migraine patients are disabled, I work full time in a demanding profession. He insists I track pain levels for a daily migraine, I tell him if I focused o. It all the time I’d be ready to jump off a bridge… then point out that since I keep pounding on when his other patients arent fairing as well maybe he should reconsider his stance but until they kill the insistence on numeric pain tracking by insurers I don’t see this happening

  • Luna
    4 years ago

    I’ve kept track of when I take meds and what days were bad days for years. Now that they are constant to some degree I keep tract of meds so I don’t over use. Then a few years ago started tracking food and supplement intake trying to find any triggers there. Never found anything useful but still keep my records just to know when what happened. But I have never kept detailed track of symptoms or levels of pain. I lived through it and don’t need to dwell on it. I have better days and worse days. Only to people who care but don’t understand do I explain about the whole body experience, it’s not just a headache.

  • Holly H.
    4 years ago

    Kerrie, that last sentence speaks to me. After 5 years of constant migraines, I don’t like giving these intractable 3 types of migraines that much detailed space in my thought-life every day. For me, it’s just a general data check-in where I just jot down in my BP record book if there’s something that perhaps needs watching or I see a trend.

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