Why keep a migraine diary?


A diary helps us and our medical provider identify the frequency and patterns of migraine attacks.


“Keeping a headache diary is still very, very important. It can be important for triggers. Some individuals might actually say, ‘Hey I have actually noticed that whenever I have a migraine attack, that is a day that I actually ate Chinese food that was takeout,’ and they can kind of say, ‘OK, well maybe it is the MSG that's a common trigger and I'll start avoiding that. However, the overall goal of a headache diary is to help your headache specialist be able to manage your migraine better.
“It's key for many reasons. One is to really determine how many days out of the week or month you're truly having a migraine attack, because that's key for determining what your treatment regimen is going to be. That's key for determining if all you need is an as-needed medication or do you also need a preventive medication. It's key to determine if you have episodic migraine — less than 15 headache days per month — or if you have chronic migraine —15 or greater headache days per month. Those are disorders in the same spectrum, but still we are typically more aggressive in chronic migraine, and there are some treatment options that have been shown to be effective in chronic migraine but are not effective in episodic migraine. So those are some of the reasons why keeping a headache diary is important.
“The other reason is because of seeing patterns. That will also help the headache specialist determine what is the treatment regimen. There may be patients that have a pattern that shows migraine attacks throughout the course of the month without much rhyme or reason. But then there might be that other patient that actually looks like they have three migraine attacks, three days in a row every single week. If I look at that pattern, I know that I need to work on their as-needed treatment plan. Why? Because they're likely having four migraine attacks per month but their as-needed treatment plan is not effective. So their migraine attack, rather than lasting several hours, is lasting for several days. If I can work on their as-needed treatment plan, they're not gonna have four potentially headache days per month where it's just that individual attack. That's how the pattern can help us.”


Using a diary, your migraine specialist can identify the frequency and patterns of your attacks, and adjust your medications and lifestyle recommendations accordingly.

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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.

Interviews from Amaal J. Starling, MD, FAHS, FAAN

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