How to keep a headache diary

When a doctor asks, “How many headaches did you have last month?” most people have to guess. A headache diary replaces the guess with a record, and it is one of the most useful things you can bring to a headache appointment. This article explains what to write down, how long to keep a diary before a visit, how doctors use it, and what else to bring. The same ideas work on paper, in a spreadsheet, or in an app.

What to write down

You don't need to write a book. A diary works best when your doctor can read it quickly, so start with the basics below and add more only if it stays easy.

Aura means changes such as sparks or bright spots in your vision, or tingling on one side of your body, that can come with migraine. If you get aura, write down what it was like and how long it lasted.

If you can, add possible triggers

Once the basics feel easy, you can note things that may play a role, such as sleep, stress, skipped meals, alcohol, weather changes, and your period. Keep in mind that attacks often come from several triggers adding up. Some things that look like triggers can actually be early signs of an attack, such as craving a certain food or suddenly finding light hard to bear. Your doctor can help you sort out what really matters. If you think the weather plays a part, see barometric pressure and headaches.

Tips to keep it going

• Mark headache-free days too. A blank day could mean no headache, or it could mean you forgot.
• Pick a set time, such as right before bed.
• Don't aim for perfect. If you miss a day, fill in what you remember the next day.
• Use the same pain scale every time so your entries can be compared.

How long to keep it before a visit

Aim for at least 1 month, and 2 to 3 months if you can. The international classification that doctors use to diagnose headaches notes that frequent headaches usually need a day-by-day diary for at least a month to describe well. A longer record also shows whether a bad month was unusual or part of a pattern.

If you have periods, mark the days you bleed. Migraine linked to periods is defined by attacks that happen from 2 days before your period starts through its third day, in at least 2 out of 3 cycles. A diary that covers about 3 cycles lets your doctor see whether that pattern is really there. Learn more in menstrual migraine.

How doctors use your diary

Your doctor will look for a few key numbers and patterns.

Headache days per month

How often headaches happen is very important for choosing treatment, so count every day with any headache, mild or severe. Chronic migraine, for example, means headaches on 15 or more days a month for more than 3 months, with migraine features on at least 8 of those days. Your headache days also help your doctor decide whether a preventive treatment, one used regularly to lower the number of attacks, is worth discussing.

Medicine days per month

Count the days you took any medicine to stop a headache, over-the-counter or prescription. Taking these medicines too often can itself lead to more headaches. This is called medication overuse headache. Depending on the medicine, doctors look for use on 10 or more, or 15 or more, days a month for more than 3 months. If your diary shows many medicine days, don't stop or cut back on your own. Talk to your doctor first. See medication overuse headache to learn more.

How well treatment works

For medicine you take during an attack, a key question is whether it helped within 2 hours. In studies of migraine medicines, being pain-free 2 hours after taking it is the main measure of success. So a quick note at the 2-hour mark, such as “gone,” “better,” or “no change,” is very useful. For treatment you use regularly to prevent attacks, your doctor compares your headache days per month before and after you start it. That comparison is only possible if you have a record.

How much headaches affect your life

Your doctor may also ask you to fill out a short questionnaire called MIDAS (Migraine Disability Assessment). It asks about the last 3 months: on how many days headaches made you miss work, school, housework, or family and social activities, and on how many days they cut what you got done by half or more. Notes about missed and reduced days make these questions much easier to answer.

Paper works well, but counting at the end of each month takes time. In Zutsu Note, you log headaches and medicines in a few taps, and the app shows your headache days and medicine days for each month on charts. Before a visit, open the visit summary. It puts your last 30 days on one page that you can show your doctor on your phone. If you use Zutsu Note in a web browser, you can also print it or save it as a PDF.

What to bring to your appointment

Use this checklist the day before your visit.

• Your headache diary, or the summary from your app.
• A list of everything you take now, including prescription medicines, over-the-counter medicines, vitamins, and supplements.
• A list of headache medicines you've tried before. For each one, note the dose if you know it, how long you took it, whether it helped, and why you stopped, for example side effects. If you can't remember, ask your pharmacist to print your prescription history.
• Records from other doctors. Ask for them to be sent ahead, and bring copies of any brain or neck scans you've had.
• Your family history. Ask relatives whether anyone gets migraine or frequent headaches. Migraine often runs in families.
• Your questions and your main goal for the visit, written down. For example: What type of headache do I have? What should I do when an attack starts? What can I do to have fewer headache days? When should I call you, and when should I go to the emergency room?
• Your insurance card and a photo ID, plus a referral if your plan requires one.

When to see a doctor

• You have headaches several times a month, or they are becoming more frequent.
• You take headache medicine on 10 or more days a month.
• Headaches make you miss school or work, or leave early, at least once a month.
• Your headaches have changed, such as a new type of headache or a clear change in your usual pattern.
• Get emergency care right away for a sudden, severe headache that peaks within about a minute, a headache unlike your usual ones, or a headache with fever and a stiff neck, weakness or numbness on one side of the body, trouble speaking, or changes in vision. Call 911 or go to the nearest emergency room.

If you want to see a doctor who focuses on headaches, read how to find a headache specialist.

Sources we used

• Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (ICHD-3). Cephalalgia. 2018;38:1-211.
• Diener HC, et al. Guidelines of the International Headache Society for controlled trials of acute treatment of migraine attacks in adults: fourth edition. Cephalalgia. 2019;39:687-710.
• Stewart WF, et al. Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology. 2001;56(6 Suppl 1):S20-S28.
• American Migraine Foundation. Talking to Your Doctor About Migraine (patient guide).
• American Migraine Foundation. What Is Medication Overuse Headache? (patient guide).
• American Migraine Foundation. Changes in Headache: When to See Your Doctor (patient guide).
• American Migraine Foundation. Migraine Symptoms FAQ.
• American Migraine Foundation. 7 Tips for Managing Migraine After a Diagnosis.
• American Migraine Foundation. Migraine in the Emergency Department: When to Go to the ED for Migraine.