How I Rate My Migraines

By Lisa Robin Benson

3 min read

I have a rocky relationship with the pain scale.

Migraine symptoms besides pain

Though I think it can be a useful tool for communicating my pain level, I’ve come across several problems with it. First is rating my migraines simply on pain levels. I want to rate my attacks based on all the symptoms.

How does migraine pain compare to other pain?

I also don’t want to focus so closely on my own pain as that can sometimes magnify it. It may be part of my perfectionist personality, but I constantly re-evaluate what number I attribute to what level of pain and never feel like I get it quite right. This quest seems almost futile when you take into account the pain scale isn’t just for migraine pain, but for all pain. For example, I have no idea how a migraine would compare to childbirth, an often-used comparison. I also find many loopholes that stop me from ever rating a 10/10. For example, if I have what I consider a 10/10 migraine, and then I fall and hit my head, what is my pain level then? You get the picture.

How do I rate my symptoms?

As I explore how I felt about the pain scale, I realize that I am more interested in how the symptoms keep me from my life than how they fit on a universal pain scale. I decided a simpler system that took into account all my symptoms was in order. Here is what I came up with:

Mild

Rating 1/3: This migraine either resolves easily with medication or is not severe enough to treat. Its usual symptoms are limited to pain and mild sensory sensitivities. Because the pain isn’t severe, and my other symptoms are mild, I am able to carry on fairly normally. I may choose to limit certain triggering activities to avoid it becoming worse, but otherwise, I am not affected significantly.

Moderate

Rating 2/3: This migraine is likely more painful and comes with a few more symptoms like dizziness, fatigue, brain fog and more significant sensory sensitivities. With a 2/3 type I can still “pass” to others as normal with effort. My symptoms are often being held at bay by my medication. I have carried on with duties and responsibilities with a 2/3 but normal activities are more difficult. I can be easily distracted, move slower, and feel my productivity is compromised. I would likely be limited in doing certain types of movement and would definitely avoid situations that can trigger worse pain if at all possible.

Severe

Rating 3/3: This migraine has to have one of two elements: severe pain or other severe symptoms. Usually, it comes with both, but I’ve had silent attacks that could still be rated at a 3/3 because of vertigo, fatigue, or confusion that keeps me in bed or on the couch. This is a migraine that I cannot imagine functioning through, and any time I've tried the severity skyrockets. My medicine likely does not touch it until I take repeat doses, if at all. It usually has to go away on its own, and hopefully sooner rather than later!

How has this helped me analyze my attacks?

Having this rating system has helped me to simplify my migraine diary and look clearly at how my migraines are affecting my life. For example, a goal I have is to never go above a 2/3. There have been situations in the past when my specific pain levels have mattered more, but for now, this system suits me well.

How does my doctor feel about my rating system?

My doctor is happy to work with me, but if she weren’t then I would simply transfer the numbers to the more traditional pain scale when needed. I would definitely recommend thinking about designing your own system customized to your migraine types, goals, and needs.

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.

Join the conversation

Please read our rules before commenting.

violetculture Member
A couple of years ago I decided myself that the level 10 pain scale doesn't work for me. I invented my own 4 level scale, which is similar to your three levels. For example, how do I rate a hangover day, without pain but with severe fatigue, wobbly legs and lack of concentration? I still don't dare to give it a "1", maybe because then I would have to admit that these days are full migraine days as well. I put in a tilde (or swung dash) to indicate those days without pain, but with other neurological symptoms, including hangover. Great article.
1. not found
 The problem with the pain scale in general is that it's not suppose to really be a "10 step classical well-defined scale". Across the medical field as a whole, it is suppose to be up to personal interpretation. This is because we all feel pain differently. How one person reacts to pain is completely different to how another person reacts to pain. One misconceived notion I hate to hear people say is that "so-and-so has a high pain tolerance". Science is discovering more and more about why humans feel pain, and why some of us feel "more" pain than others. For example. science recently discovered that Red heads tend to have more nerve endings than other hair-colored people & thus tend to often be more "in tuned/sensitive" in terms of pain and health problems. We also know that women have more nerve endings then men which is why we tend to "feel" more pain than men. This is not true in every case, just in the general majority. Regardless, I find that I can tolerate some types of pain better than others, and I've heard others say the same thing. Some people don't mind the stinging of a burn but cringe from needles. Others are not bothered by needles but cry from burns. Maybe it's genetics, maybe it's our crazy brains. Whatever the case, I think medicine & science needs to do a better job at figuring out why we feel pain and to find a better way of understanding people who feel pain more frequently.
2. Lisa Robin Benson Moderator & Contributor
 Hi Violet, This is the pain scale I have referred to when I must rate a migraine from 1-10: <a href='https://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/0-10_Pain_Scale.pdf' target='_blank' rel='noopener noreferrer ugc'>https://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/0-10_Pain_Scale.pdf</a> Lisa
kellijanesmith Member
I couldn't believe it when I read your post Lisa. I use a nearly identical rating to yours except I call them MILD, MODERATE, SEVERE. I just wanted something where I created my own very simple definition for them in my own migraine diary so I could see whether a day was CLEAR or whether I'd experienced one of the other three types of migraine days (and a pain scale just didn't make sense... you are so right about that!!). Then I just make a note of what else happened for that migraine... what meds if I took any (like you, on a 1 or MILD day, I may not take any meds), and how did I respond, etc. I hadn't thought anybody else but me was rating their pain like this, how cool to have just popped in here to find that I am not alone.
1. Lisa Robin Benson Moderator & Contributor
 Hi Kelli, Just like you, I am now popping in here to find I'm that I too am not alone! 😀 The only reason I don't use the terms "mild, moderate, severe" are because I was concerned that doctors would have preconceptions of what those terms mean (and also it's quicker to write numbers), but essentially it's the same thing. Anyway, I'm very glad we can help and learn from each other! I wonder how many of us want to graduated from having to use the pain scale? Lisa
delaney7 Member
hm. I get the desire to get away from the pain scale but 3 categories seems too few for me. I also want to be able to distinguish between migraines with nausea or vomiting versus migraines without other severe symptoms. I haven't come up with an answer for this, mind you, but I'm just thinking out loud.
1. Lisa Robin Benson Moderator & Contributor
 Hi Delaney, Have you tried maybe using a color code? So one color could be for migraines with nausea etc. and another color could be for those without? Lisa
2. not found
 I posted above as well, but there's a red-light-green-light method I've heard. While it uses only 3, the idea is that you could "add" in mid-level colors, or use 2 colors for in-between. Think of when your car comes to an intersection (i.e. you brain gets a migraine). Green = You have a migraine but it doesn't impact your everyday activities. You don't have to take any meds & you don't feel any loss of function. However you are aware of the presence. (You can dictate this level to whatever is "green" for you). Yellow = Slow down - You may or may not have taken meds (tripans, NSAIDS, etc) with little relief. Your daily activities were impacted some, but not completely. You were still able to do some things. Red = STOP - Took meds with no relief, unable to do anything. The migraine completely disrupted your day and nothing was accomplished.
bethyoung Member
Lisa...first..thank you so much for this article!! I agree with you, as today I've been having auras (flashing lights) on and off all day, with nausea and vertigo. But I've only had a slight headache. I like the idea of the different numbers and colors. I'm going to have to figure out how I want to do this but it's better than the old pain scale!!
1. Lisa Robin Benson Moderator & Contributor
 Beth, You're welcome and good luck! Lisa
jo17151 Member
I switched to the 1-2-3 a few years ago at the request of my neurologist. Each month I have a page with several columns (due to other medical conditions plus a "yes" or "no" column for headaches and a line for medications.) To keep the insurance approving treatment, the neurologist wants to know # of migraine attacks per day and # of headache days per month. For treatment purposes, he wants to know if there is any change to the severity or duration of the attacks or if there is any change to symptoms or auras or non-migraine headaches. On the bottom of my tracking page, I'll note anything outside my norm (such as new symptoms or increased severity or duration). Not all my migraines are with an aura - so I'll put an "a" beside the number if there was one. It really was hard to let go of the 1-10 scale - but 1-3 is so much easier to record as well as pretty quick to tally up at the end of the month. Lisa, even my criteria for rating is very similar to yours, basing my rating on how the symptoms impact my ability to function. I really like the details you've included with your ratings. Thank you for a very helpful article
1. Lisa Robin Benson Moderator & Contributor
 Thanks Jo, And good addition to the system by noting anything out of the norm! Lisa
not found
Having spent 12 years working in the health industry, I loathe the pain scale. I've never felt comfortable rating pain anything over an 8 because I always feel that it could be worse. I also have this notion that if I'm not feeling in enough pain to go to the ER than how on earth can I rate my pain at an 8. Ironically, the higher my pain goes the less likely I am to go to the ER because the noises and lights and chaos in an ER send me into worsening spirals of suffering & I'd rather be at homing dying than be at the hospital getting treatment. Yes I hate ERs & I worked in 1 for 3 years). I did read an idea of the red-light-green-light idea not long ago and I've since tried to adopt that method for rating my headaches instaed of the pain scale. Basicaly Green means I had a migraine but it didn't interfere with normal activities, Yellow means it interfered but I was still able to participate in some sort of activities. While Red means that I had to stop all activities. Which ever light my migraine reaches for the day, that's the color the whole days gets. So, if I miss work, that's a red-light day. If I go to work, but I have a hard time focusing, that's yellow. On the (very) few days that I'm completely headache free - those days get no lights, it was smooth sailing all the way. A rare thing for me. However, while this system makes rating my migraines somewhat easier, I still run into problems in terms of the side effects (4 phases of migraines) and how to decide when and where to rate them. Especially since everyday I'm earning what symptoms are actually related to my migraines that I wasn't aware of before. So sometimes I'll realize 2 days later that a symptom I had earlier in the week was predrome. The problem is that in hind-sight I often tend to minimize the impact or lessen the pain level. I'll say, "oh it really wasn't that bad", or "I don't think it's worth marking at xx level".
1. Lisa Robin Benson Moderator & Contributor
 Sarah, I love this analogy! It really works! Thank you for sharing.
monkeybrew Member
Lisa, thanks for this wonderful article! And to everyone who has posted a comment, thank you too for the variety and similarity of rating systems. Having come out of the Michigan Head Pain and Neurological Institute's inpatient Head Pain unit three or so weeks ago I am fresh of the experience of rating my migraines on a one to five and one to ten scale several times a day (and night). Even in an outpatient setting the first thing after checking in is the completion of a form that includes rating migraines at the various pain levels. I tend to assess my ability function rather than put too much time into assigning a number. Don't get me wrong, I do keep track of the numeric rating as the team at MHNI both expects it and uses it to compare to previous visits. The reality of day to day live, however, comes down to whether or not I can make my way through the day I had planned (work, time with family, errands, projects, etc.). Does the migraine keep me from going to work, as it has yesterday and today, or do I make it to work but function with lower productivity due to cognitive issues? Some days are a little of everything. I can make it to work and be very productive in the morning. The afternoon brings a fast moving migraine which derails everything. I leave the office for home. At home the migraine takes over and I end up in a dark room before dinner. In rating the migraines I am really rating is how the migraines interfere with life. Unfortunately, the answer to that lately is a lot (8-10, 4-5, red and sometimes yellow, brick wall rather than one made of styrofoam blocks, etc,). I love the idea of being flexible and finding a rating scale that fits! MB
1. Lisa Robin Benson Moderator & Contributor
 MB, I think this is brilliant! Thank you so much for sharing. Lisa
shortymorgan Member
thank you all for you comments. Great ideas. Although I have had migraines for years, just started formally doing migraine diary. getting lots of ideas. yes, it too is hard for me as a chronic mirgainer how i start out the day in terms of pain intensity is not how i end the day, especially on days that i work and have a migraine. being able to communicate to my dr not just level of pain, but impact on my life and what makes it worse is important.
sunupshutterbug Member
This is basically the system I use! Couldn't agree with you more. Migraines are so much more than 'headaches' and this system takes that into account.
sroden Member
I have always hated the standard pain scale. I tried to explain my frustration to one of my neurologists. I told her that when they ask, "On a scale of 1 to 10, with 1 being zero pain and 10 being the worst pain imaginable, where would you rate your pain," I don't feel comfortable rating anything above an 8 because I have a good imagination. She said that it's probably not that bad then. I switched insurances, and neurologists, shortly after. I hadn't put a name to it, but I too gauge my migraine based on functionality, and then I translate those to the standard pain scale for the purposes of ER visits and fitting in the boxes they have. There are functioning days, semi-functioning days, and non-functioning days. I did learn, through my husband's inpatient stay for back surgery, that the nurses would not give certain pain medication for pain levels under a 6. He, too, doesn't like to overstate his pain because he has a good imagination as well. So even when he was squirming uncomfortably, in obvious pain, he would say hi is pain was at a 5. One nurse explaned how their system worked and told him was pain was probably at an 8 (wink, wink.) So yes, the standard pain scale doesn't work for me. And you're right- It doesn't take into consideration the other symptoms like nausea, light/sound/smell sensitivities, hearing one's pulse in one's ears, etc.
andreak Member
Thank your or this article. This approach seams very useful. I vote for creating a Color code!!!! A spectrum! for Symptoms, Difficulties of all sorts and a rating for how much of a challenge it was to do what has to be done. I have had chronic daily migraine for years. Sometimes I need the perspective of my partner who says...You look like you are hurting..then notices changes in my facial expression, speech and mood or thinking...before I notice. I guess I have grown to accept so much variability that I no longer sense the edges of states of dis-ease. When I am migraine free, I know it! So I take my blood pressure. Usually quite low and healthy. If it is up, that is a sign of pain. Of course if I am curled up in bed that is clear, or if it take an hour of determination to get out of bed because of achiness and absence of enthusiasm only to find when I get to the bathroom that my eyes are barely openable....that is clear. But much of the time I experience some intermediate state of being. These multiple states of pre and postdrome or some arbitrary manifestation of cortical spreading depression or blood flow asymmetries....produce a spectrum and complexity of symptoms that defies rating on a traditional pain scale ...as far as I am concerned. I vote for a scale that rates ability to participate in life's activities and to experience joy or pleasure as a primary scale for migraineurs. Respect for the gradations of difficulties we have to tolerate like brain fog or the ability to push through in spite of.. are important experiences that measure the courage, determination and exhaustion that seems to be part of accepting the reality of Migraines. The black and white classification system of counting "events" is old fashioned and fails to address the practical realities we all cope with. How about a including a scale for courage , determination and the ability to experience focus, joy, generosity of spirit ? What about a count of how many moments of a sense of ease are possible in a day?
crystalrz4 Member
I also rate my migraine pain based on both the pain of my migraine and EVERYTHING that is affecting my migraine at the moment. Most of us understand that any and all other aches and pains, illnesses, injuries, weather and EVERYTHING can influence the pain/hence the rating of a migraine (at least it does with mine). So in my migraine log, I DO list everything that I know to be affecting my pain! I completely agree with you that when I need to describe my pain, I then have to look “Inside” and “Internalize” that pain in order to describe it. That of course does seem to magnify the pain or allow it to come forward to the full extent of the true pain. I usually have to take breaks to get away from it for awhile before I can go back and finish writing it up. I also have re-examined those pain level numbers. An “8” can be an “8” one day due to ALL the pain forcing it, or might be a “6” the next day because some of the other influences aren’t present. Since I have gone through childbirth (4 times) I do know that pain. I’d much rather go through my longest and hardest childbirth (4 days, 13 hours, 44 minutes, not from the being but when true labor started), than to go through my worst migraines ever again!!! Also, doctors like to compare it with kidney stones, and YES, I’ve had those too. Yes! They hurt! But in my humble opinion, my severe migraines are FAR worse. There have been a few times that “10” was not even close to sufficient! What has pushed mine so far over the top, is that I had had migraines since I was very young, and one day I woke up and KNEW I was dying!!! I had Meningitis! After I was declared well, the doctor asked me if I had migraines, of which I said, “Yes!” He patted my arm, and said that from point on, my migraines would be much worse. He was right. Due to the fact that my own situation is so different than most peoples’, I try to evaluate my migraine condition when it comes time to take my medicine. Due to all my other health problems, so far, there just aren’t any Migraine Preventatives that I can take. I do take two prophylactics, one for migraine induced Prinzmetal’s Angina, the other is as Migraine preventive. Which I don’t actually notice that it helps much, but if I DO miss taking it, my migraines can and do get more severe! The other two medicines that I take are Rescues. I do have some other techniques that I put into play with limited success, but together it is what I have. So I imagine that most people’s ratings for pain are probably as individualized as their pain is to them. Not to mention, each person’s perception of pain is as individual as they are! I guess this scale is as good as they can come up with for the general population.
peeprview Member
This is amazing to me because the pain scale you've come up with is exactly the same one I came up with for myself! After years of having the same conflicts you described with the traditional scale I came up with the 1,2 or 3/3 scale based on levels of function. Because after all, isn't that what it all comes down to most of the time? Whether we can function or not? I think for others, at least, that's really all they want to know. Plus, on the traditional scale I would get all tangled up trying to figure out the differences with all the in- between numbers. Like "Am I a 3 or 4? Or maybe 2?" And there's Way too many in-betweens between 5 and 10! They all seemed too ambiguous, who needs 'em? I think it's too cool we came up with the same scale for the same reasons. I find it very validating. Thanks for writing this piece!

Community Poll

Do you feel comfortable advocating for yourself to your healthcare provider?