How to Keep a Migraine Diary: What to Track and for How Long

If you want to keep a migraine diary, here is the short version: write down every attack with its start, its end, how bad the pain was, and whether you took anything for it. Mark the days you had no headache at all. Keep it for at least two months before your appointment, ideally three. Everything else is optional.

I have had migraine since I was five, and I have kept a diary in every form there is: the paper calendar from my neurologist’s office, a notes app, a spreadsheet, and finally the app I built for myself. This is what I wish someone had told me at the start.

Why doctors ask for a migraine diary

There is no scan or blood test for migraine. The Migraine Trust puts it plainly: “There is currently no test to diagnose migraine.” Diagnosis depends on your doctor taking your history and ruling out other causes (The Migraine Trust, Diagnosis).

That history is what you bring. The same source lists what a doctor will ask at a first visit: how often the attacks happen, how severe the pain is, what other symptoms occur, and which treatments you have tried (The Migraine Trust, Visiting your GP). From memory, two months later, most of us get these numbers wrong. A diary gets them right.

The four things to record every time

Most diary templates list fifteen or more fields. Weather, food, sleep, hormones, stress, screen time. When your head hurts and you have thirty seconds, fifteen fields means you write nothing. So start with the four things every doctor asks about:

1. When the attack started. Date and roughly the time.
2. When it ended. Attacks typically last between 4 and 72 hours (ICHD-3, 1.1 Migraine without aura, criterion B), so this is often a different day.
3. How bad the pain was. A simple scale is enough. Mild, moderate, severe, or 1 to 10. Be consistent.
4. Whether you took acute medication, and what. One entry per intake. The number that matters later is the number of days with an intake, not the number of tablets.

That is the minimum useful set. If you record only these four, your diary is already more useful than a vague “a few bad weeks”.

Useful extras, all optional

Once the four basics are a habit, these add context:

• Symptoms: nausea, sensitivity to light or sound, visual disturbances.
• Aura: whether you had one, and what it was like.
• Pain side and character: left, right, both; throbbing or pressing.
• A short note: anything you would want to mention at the appointment, in a sentence.

IQWiG, the German institute for quality in health care, describes a diary that over several weeks or months records timing, duration, intensity and medication, and optionally sleep, stress and food (IQWiG, Migräne-Tagebuch). Notice the order: the attack data comes first, the possible influences last.

What not to do

Do not go trigger hunting on day one. Most new diaries die under the weight of logging every meal and every hour of sleep. Record the attacks first.

Do not mistake early symptoms for triggers. Many attacks begin with a prodrome: cravings, yawning, mood changes, stiffness, hours before the pain. The Migraine Trust points out that these early signs are easily confused with triggers. The chocolate you craved on Tuesday morning may be the first sign of Tuesday night’s attack, not its cause (The Migraine Trust, Prodrome).

Do not skip the good days. A diary with only bad days looks worse than your life actually is, and your doctor cannot tell a quiet fortnight from a fortnight you forgot to log. Mark the headache-free days, even if it is just a tick.

How long to keep it, and why three months matters

For an appointment, keep the diary for at least four to eight weeks beforehand. Ideally three months. The reason is in the diagnostic criteria doctors use.

Chronic migraine is defined in the International Classification of Headache Disorders as headache on 15 or more days per month for more than three months, with migraine features on at least 8 of those days (ICHD-3, 1.3 Chronic migraine).

Medication overuse headache is defined over the same period. The DGN and DMKG guideline (AWMF 030/131) and ICHD-3 section 8.2 use the thresholds of 15 or more days per month for simple painkillers and 10 or more days per month for triptans, opioids and combination painkillers, for more than three months (DGN/DMKG S1-Leitlinie, 2022). What that means for your own medication is a conversation for your doctor. What it means for your diary is simple: count days, and keep counting for three months.

Paper or app

Both work. Paper is free, needs no battery, and the calendar your doctor hands you is already in the format they like. The downsides: it is rarely with you when the attack starts, and adding up days per month is your job.

An app is usually in your pocket, so you can log the start of an attack from bed. It keeps all your entries in one place and can print a summary for your appointment. The downsides: it is one more app, and you should know where your data goes before you type your health history into it.

Whichever you choose, the diary that gets filled in is the right one.

If you prefer an app

I built Migrania because I wanted to log an attack in seconds, even mid-migraine. It records episodes and medication intakes, shows them on a calendar and as charts of your own entries, and exports a PDF you can bring to your appointment. Your entries stay on your iPhone. It is free, and there is no account.

Whatever you use, start with the four things, keep the good days in, and give it three months. Then bring it with you.