Keeping a Migraine Diary: The Basics
Keeping a migraine diary gives you vital information that can help track down the patterns of your migraine attacks – when and how often they occur and how long they last, what your symptoms are (before, during, and after the most painful phase of the migraine), what your pain levels are, where the pain is located, what meds you take and if they work, what your potential triggers are, and so on. Over the long term, the diary can show you how effective a preventive treatment is for you, whether your abortives are working optimally, and what other symptoms you might need to treat.
How do you know what's significant?
Too bad keeping a migraine diary can be a huge drag. Covering all the potential triggers, symptoms, and details we're required to remember and recording a lot of minutiae, some of it retroactively. Identifying the significant parts can seem impossible. Do you include the weather? Does it matter that you had a glass of wine 22 hours before the migraine hit? What if your pain fluctuates throughout the migraine – do you record the highs or the lows? If you have chronic migraine and can’t tell when one migraine attack stops and another one begins, how do you record the time of onset and duration?
Keep your migraine diary simple
The best way to gather this valuable data without getting overwhelmed is to keep your diary as simple as possible. Below are the basic recommended areas to cover, which I gleaned from the diary that a famous headache clinic uses for its research and combined with my own suggestions and those I’ve learned from other migraineurs. Since not all the questions will apply to everyone, I’ve listed them out in narrative form. Once you decide which questions to include in your own diary, the format is up to you. Maybe you print out a list of questions, create a simple spreadsheet, jot down your answers on your daily calendar, or keep track in your phone’s notes app. Again, it’s all about finding the method that you’re most likely to keep up with. It doesn’t have to be fancy, you just have to use it.
What time did the migraine begin? How long until you were entirely pain-free? (This won’t apply to some chronic migraineurs – jump straight to the severity questions, which also record duration.)
How painful was the migraine at its most severe? How long did the severe pain last? What was the average pain of the migraine? (As a chronic migraineur, I find it helpful to record my daily low and high pain levels and the duration of each.) Many people find a 0-10 scale the best way to record pain levels, others rate it on a scale of mild-moderate-severe, still others assign colors (either green, yellow, and red like a traffic light or their own colorful scale).
What are the top three most bothersome symptoms? You can list more and can even rank them, but be sure to get the basics down.
What abortive medications or painkillers did you take and what was the dose? Record either the time you took them or approximately how far into the migraine symptoms you were before medicating.
Quality of Life
Using the green, yellow, and red traffic light system to record how your life was affected during a migraine is a very easy way to capture a huge amount of information. This one isn't strictly necessary but communicates the burden of migraine to your doctor succinctly and powerfully.
That’s it for the most important questions. That’s right, you can get the most important data by answering those few questions. Sure, it can be helpful to provide more information, but if you can only deal with the basics, then having those few details is better than none at all.
The note card method
P.S. Don’t want an at-a-glance record of your life’s most painful moments? Write down the basics on a note card. You can flip the card over and never look at it again, but at least you have the data and can show it to your doctor. For many years, I refused to keep a diary because, without it, I could pretend I wasn’t as sick as I really was. Hiding from the truth only made it more difficult to get good medical care and figure out if preventive medications were working for me. The 3x5 card method was a step forward in my care.
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