Tracking Migraine: The Journal is the Key

In order to begin to understand the triggers and patterns surrounding patient migraines, headache specialist Stephanie Nahas, MD, MSEd, recommends patients keep a migraine journal or calendar.

Nahas, an associate professor of neurology at Thomas Jefferson University in Philadelphia, Pennsylvania and director of the university’s Headache Medicine Fellowship Program for the Jefferson Headache Center, says the journal is useful to gauge the actual burden of illness the patient is experiencing.

Writing down the details of a migraine attack can reveal to both physician and patient how migraines impair a person’s daily ability to function at home, at work, and in leisure, as well as the frequency of attacks and what medications are required to control them, she says.

Additionally, a migraine calendar can help patients discern between actual triggers and those that are just coincidental.

“Many patients may not be sure they have real triggers or not, so keeping track can help to tease out what’s a trigger,” Nahas says.

Triggers can run a wide gamut, including sleep, diet, exercise, dehydration, stress, and hormones-to name a few.

With a journal, a patient can notice the circumstances surrounding a migraine. “You can take notice of how your sleep was the night before, did you exercise today, how’s your hydration and are you stressed out,” Nahas says.

A journal can also help to track the benefits of what is known as a “protector,” which Nahas calls “the opposite of a trigger.” Protectors are factors that make it less likely that a person will have an attack. This could be a new medication, lifestyle modifications, acupuncture, and so on.

Identifying Patterns with a Journal

The calendar can also be of great use to the physician, Nahas says, as a way of monitoring acute medication use. “If somebody has headache more than 10 days a month, you need to monitor how often they’re using acute medication to treat attacks because they could get into trouble with rebound headache,” she says.

Rebound headaches are part of a cycle where the patient has to keep taking more and more medication to treat the migraine and the migraines then begin to increase in frequency and intensity.

“Keeping track on a calendar may be the only way to determine that,” Nahas says.

Migraine journals eventually begin to reveal patterns that can also help patients prepare a pre-emptive strategy, Nahas says.

For example, if the weather or a menstrual cycle is the trigger, “The day before you expect the headaches to start picking up, start loading up with anti-inflammatories,” she says.

Most important, migraine journals are a way for the patient to write down their feelings about migraine’s impact on their lives, and bring it to someone else for validation and help.

If a physician recommends a patient begin using such a journal, physicians better use and look at them during the visit. “Because nothing insults somebody more than being told to do something but then the doctor doesn’t care that you did it,” she says.

There is also some stigma associated with migraine that physicians should seek to overcome.

“Unfortunately a lot of providers see people with migraine as complainers, as drug seekers,” Nahas says. “So just listening to someone with an open mind and saying ‘I may not have all the answers but I’m going to try to help you live your life to the fullest’ really goes a long way.”

Jordan Rosenfeld is a contributing author.