What is a quick, effective way to keep a migraine diary?


Especially if you have frequent migraines, keep a simple paper calendar and mark green, yellow, or red for the days you have mild, medium, or severe attacks.


“One of my favorite diaries though is actually very, very low-tech. This is the one that I've actually seen has the most compliance with patients. So what it is, is actually getting an old-school calendar, then having either three colors of stickers or three colors of markers right next to it. I have patients keep it right next to their toothbrush. If it is a perfect day, you don't put any mark. If it's a green day where you're, you know, maybe there's a mild headache but in general you're functioning at full capacity, you can put a green mark on that or a green dot. If it's a yellow day, it's a day where you may have had to use your medication, it impacted your function a little bit but you were able to get through the day. Then if it's a red day, it's one of those days where you're really debilitated by your disorder. You may have to stay home from work, you may not be able to be as productive as you are at home or at work. You may have needed to have taken various medications.

“So, especially for my patients that have very frequent headache days and migraine attacks, for those individuals, that simple diary can sometimes be very, very useful. The other thing we'll say is that ideally ... especially for my patients that have maybe daily headache that's very severe and when they initially come to see me, they may have all red days and a couple yellow days. For them I say, ‘You know what, we are going to engage in the green revolution. Over time, we're gonna see that all these are gonna be green.’ What's really cool is, it's almost like a little flip book. Like a movie, so as we've been following these patients for years they come and they bring their calendars with them and then I can kind of flip through it and say ‘Look at that, we see more green days.’

“Again it's a very great visual way to look at patterns as well, ‘cause if I see there's three red days in a row again, I need to work on, what happened on that day: ‘Oh, you know what Dr. Starling, I forgot to take my as-needed medication with me to school. So I didn't take it until six hours into my migraine attack.’ OK, so let's talk a little bit about how you need to use your as-needed medications earlier in your migraine attack, because that's when it's most effective. It helps us very easily and quickly, in less than a minute, know what my next step would be in migraine management.”


A very simple migraine diary can quickly and easily reveal patterns in your attacks. This can help your medical provider target treatments and preventions that will be the most effective.

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Amaal J. Starling, MD, FAHS, FAAN

Mayo Clinic, Arizona

Dr. Amaal J. Starling is an associate professor of neurology at the Mayo Clinic College of Medicine. She joined the Mayo Clinic in 2012 and is currently a consultant within the Department of Neurology. Dr. Starling received her medical degree from the Drexel University College of Medicine in Philadelphia. She completed a transitional year residency, a neurology residency, and a headache fellowship at the Mayo Clinic College of Medicine in Scottsdale, Ariz.

Dr. Starling is an active member of numerous migraine advocacy organizations, including the American Headache Society (AHS), the American Migraine Foundation, and the American Academy of Neurology (AAN). She is also involved in events supporting migraine, including Headache on the Hill, Miles for Migraine, and the Alliance for Headache Disorders Advocacy. Dr. Starling is currently serving on the AHS Board of Directors and is the chair of the AHS Advocacy Committee and a member of the AHS Diversity, Equity, and Inclusion Taskforce. Dr. Starling has been the recipient of numerous awards, including the AHS Above and Beyond Award for Service, Manfred D. Muenter Award for Excellence in Clinical Neurology, the AAN Annual Meeting Residency Scholarship, the 2012 Spirit of Mayo Clinic Award, and the Mayo Brothers Distinguished Fellowship Award.

Dr. Starling has authored numerous peer-reviewed publications and abstracts related to her fields of interest, which include migraine, concussion, post-traumatic headache, neuromodulation, and telemedicine. Dr. Starling’s hope is that her research and advocacy will advance care for people with migraine, post-traumatic headache, and other headache disorders. She envisions a future in which all people with headache disorders receive personalized, effective, and well-tolerated treatment options to improve their quality of life.

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