Migraines can come suddenly, often without warning, and can even slip up on you while sleeping. Migraine is a very disabling neurologic condition. Keeping a Migraine diary can be helpful for personal revelation and observance of Migraine patterns. The diary will also be helpful for your doctor to study when you go in for a visit.

This is an article by Britt Talley Daniel MD, member of the American Academy of Neurology, migraine textbook author, podcaster, YouTube video producer, and blogger.

What should you track in a Migraine diary? In your diary track:

· onset of your Migraines

· duration of Migraines

· pain intensity on 1-10 scale

· Migraine relationship with menstrual cycle

· sleeping pattern and night-time occurrence or wake up headache

· stress pattern

· dietary foods

· medications used for treatment

· weather change

· missed meals

· the side of head involved with your Migraines

· the time medication was given

· medication retreatment

· side of head involved

· any accompanying symptoms-nausea, vomiting, light sensitivity, sound sensitivity, olfactory sensitivity, need to be down, work or school missed,

· Migraine triggers

· days Migraine free.

How come Migraine involves so many features of a normal life?

Persons with Migraine have inherited a special brain that is more sensitive to light, sound, eating, sleep, stress, and estrogen levels than the normal brain. Migraine cuts into the nitty gritty of everything you do.

Migraine inflames the sensory nerves in the brain to cause symptoms:

· The first cranial nerve for olfaction which makes the person sensitive to certain odors.

· The third cranial nerve, the ophthalmic nerve, which makes the person sensitive to light.

· The eighth cranial nerve, the auditory nerve which makes the person sensitive to sound.

Migraine can also turn on the vomit center in the brain stem making the person nauseated and vomit. Migraine with aura patients can have visual spots or holes, numb fingers, arms, or face, or trouble talking thought to be related to a cortical spreading wave of depression which sweeps across the occipital lobe and forward to the parietal lobe, effectively turning off brain activity in these sensory areas.

The brain then resets in a few minutes.

Migraine makes a person need to lie down, like in bed or a couch, and feel so sleepy, and tired, and sick that they cannot get up to do almost anything. They are disabled. They miss work, school, or their children’s soccer games, and many other important parts of their lives.

A Migraine Diary may be kept in a notebook.

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or in a Migraine Cell Phone app.

Read my Mini Book on Migraine Here.

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Who says the duration of a Migraine is from 4 to 72 hours?

This time period is defined by the International Classification of Headache Disorders 3 and relates to the fact that during a Migraine the inflammatory chemicals Neurokinan A, Substance P, and CGRP are released. These chemicals inflame the trigeminal pain nerve, the cerebral arteries, and the thalamus, the pain center of the brain.

When these chemicals come out it takes 72 hours to get from the brain, to the liver, and then out into the toilet. This fact is known by measuring the chemicals as they pass through the human body. Since one single episode of migraine can last 4 to 72 hours, hopefully the patient will be using a triptan and can get a headache free experience within two hours.

If effective treatment is not occurring, it is important for the doctor to note so he may consider increasing the strength of the acute therapy medication or adjusting the dose to something else.

People will say that they had a Migraine that lasted for a week or a month or 6 months, but they are not describing a single Migraine which can only last 4-72 hours, but rather a condition called Chronic Migraine which usually relates to medication overuse and which gives continuous or near continuous headache. Medication overtreatment causes frequent or continuous Migraine headaches.

What is the pain intensity of a Migraine?

The pain intensity of a Migraine is usually from 7-10 on a pain scale relating headache from 1-10.

Migraine and Tension Type Headache are 99% of headache. Tension Type Headache, by definition from the International Classification of Headache Disorders 3 (ICHD), causes only moderate headache pain that does not go over level 5, while my Migraine patients tell me theirs go to “20.” (joke)

Thinking this way, any severe headache is usually a Migraine.

What is the relationship of Migraine with a woman’s estrogen level?

During a woman’s normal menstrual cycle, the brain gives a signal to the ovaries to produce estrogen for the first 3 weeks of her cycle. Then, this signal is turned off, the woman bleeds, and the ovaries produce progesterone for another week. Then the cycle repeats.

The fall of estrogen after the third week of the menstrual cycle is strongly related to Migraine headache occurrence.

Migraine patients with Migraine without aura will usually have a Migraine during their cycle and at other times during the month.

Migraine patients with Pure Menstrual Migraine only have Migraines during their cycle.

For most women, their menstrual Migraines are their longest, the most severe, and the hardest to treat.

Read my article, “Menstrual Migraine,” on my website, www.doctormigraine.com.

Does Migraine relate to sleep?

Migraine is comorbid with Depression 50% and with Generalized Anxiety Disorder 40%. Both of these psychiatric conditions have trouble sleeping as cardinal symptoms.

In general, even without a psychiatric condition, Migraine patients do not sleep well. Sleep studies show they only get to light sleep, but usually not deep sleep.

For these reasons Migraine is directly related to a person’s sleep cycle. Many Migraineurs have attacks in the middle of the night or several hours before awakening, called “wake up headache.”

Good sleep hygiene is an important part of treating Migraine.

Read my article, ”Tips on how to sleep with Migraine,” on my website, www.doctormigraine.com.

**Rock and Roll Song, “Didn’t sleep at all last night. Had you on my Mind.”**

Does Migraine relate to stress?

Stress is the number 1 issue that sets off a Migraine. The headache may come at the time of stress, or freedom from stress. It is the “let down headache.” A typical story would be the busy mother who finishes all she has to do for the Christmas holidays, and then has a bad Migraine on Christmas day.

An example of stress regarding Migraine would be something like starting a new job or preparing for finals in college.

**Billy Joel “You cannot handle Pressure”**

What about dietary factors which aggravate Migraine?

Dietary factors are hard to study regarding Migraine. See my blog article on “Migraine Food Triggers on my website, www. doctormigraine.com.”

Probably the most discussed items are Alcohol, especially red wine, chocolate, MSG, and tyramines.

I promote any Migraine patient avoiding any food they think causes headache for themselves, but the science on this subject is still lacking.

Does Migraine relate to weather change?

A fall of barometric pressure is a common instigator for the start of a Migraine headache. I hear that all the time in my headache practice. There are published neurologic studies reporting this.

I always ask patients who report barometric pressure change headaches to track barometric pressure on their cell phone and then treat early before the Migraine starts.

**Pressure going down; Migraine going up.**

Does missing a meal bring on a Migraine headache?

Migraine headaches that come following missing a meal or not eating on time are called “hungry headaches.” This is common pattern for Migraine patients who many times do not take care of themselves and eat right. Oftentimes, young women will not eat breakfast.

I point out that breakfast means “breaking the fasting of sleep.” Part of the Migraine lifestyle is eating three meals a day.

Why does Migraine occur on just one side of the head?

My answer to that is that is just the way Migraine is. No one understands this Migraine feature, but the most common symptom of Migraine that is a one-sided headache.

Galen living in (131-201 A.D.) described “Hemicrania” a term which means half of head. With time and different translations, it became “Micrania” in France in the 18th century and “Megrim” in England by the 19th century and then finally, our current word “Migraine.”

One-sided headache occurs in about 80% of Migraine patients. Also, most patients will have one predominant side where the headaches occur, such as for instance the right side. Purely one-sided headache could be something wrong with that person’s brain such as an aneurysm or an arterial-venous malformation. But if for that person a Migraine also occasionally occurs on the left side, that is a benign feature and plain old Migraine. That is what Migraine does.

Why is it important to know the time medication was given for a Migraine headache?

This is one of the most important features of migraine treatment because Migraines should be treated at onset of the headache or the aura with a triptan for most successful therapy. Taking a triptan at onset can give a headache free experience for 70 to 80% of Migraine patients.

Why is it important to look at medication retreatment?

Timing of medication retreatment is important to look at possible overuse of medication, or side effects of the medication. Triptans, again the most successful acute therapy drugs, may be retreated in 2 hours and a total dose of two treatment doses can be taken within 24 hours. However, I have seen patients taking 3 or 4 triptan doses every day for weeks to months. They come in with medication overuse headache and daily headache.

Some patients using over-the-counter drugs like Aleve or Tylenol for Migraine may take multiple doses, perhaps 4 to 6 times a day which can quickly lead to medication overuse. This is an important factor for the doctor to detect and advise the patient regarding Migraine treatment.

Why is it important to notice accompanying Migraine symptoms such as nausea, light, smell, or sound sensitivity?

Dealing just with the issue of nausea, it is important for the doctor to know this. Patients tend to accuse their medication as the cause of their nausea, yet Migraine is infamous for causing nausea all by itself and sometimes it is difficult to separate what is what.

Again, early treatment of Migraine may help get rid of the nausea and triptans are usually successful in treating nausea. Triptans may treat 80% of the nausea that comes with a Migraine Late treatment may bring on nausea and a longer-lasting migraine.

Over-the-counter medication such as NSAIDS or Tylenol or caffeine taken too much can cause gastritis and nausea. They are also not as successful as triptans would be for acute therapy of migraine.

Migraine patients during a headache like to be in a quiet, dark room. Avoiding loud noises and bright flashing lights can be helpful in avoiding setting off a Migraine.

Many persons with Migraine are sensitive to olfactory triggers. The most common ones are women’s perfumes, lotions, and cigarette smoke. Learn what your specific olfactory triggers are and avoid them.

Are Migraine triggers important to note?

Dealing with, identifying, and avoiding Migraine triggers is one of the most important part of the treatment of Migraine.

It is the patient’s responsibility to learn this. Study my blog article on “Migraine triggers” at my website, www.doctormigraine.com. Learn what your triggers are and avoid them.

Why is it important to know the days I am Migraine free?

A headache diary that only shows 1 or 2 Migraines a month for a person who previously had more is a very reassuring experience. Persons who are having frequent Migraines may be on the edge of trouble.

Episodic Migraine is defined as 14 or less headache days a month and Chronic Migraine 15 days a month, 8 of which have Migraine features. Persons with these features may be over treating and develop medication overuse headache. Being Migraine free is a blessing and would be nice to know.

In Closing: Learn to use a good Migraine headache diary for your own personal growth and for sharing with your doctor.

Check out my Big Book on Migraine Here.

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All the best.

Britt Talley Daniel MD

What Should You Track in a Migraine Diary? 2023

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