How to track migraine triggers

This page is about the triggers part. For the basics of a headache diary, like times, pain score and medicine, read how to keep a headache diary.

Commonly reported triggers

The NHS migraine page says some people find certain triggers can cause migraine attacks, such as:

• having your period
• anxiety and depression
• stress and tiredness
• skipping meals or not eating regularly
• too much caffeine
• not getting enough regular exercise

The Migraine Trust's page on triggers also covers hormones, stress, lack of sleep, skipping meals, caffeine, alcohol, specific foods, dehydration, weather changes, light, noise and smells, using a computer, and exercise.

These are things people commonly report. They aren't a checklist of what affects you.

Three things to know before you start

• Many people have no obvious trigger. The Migraine Trust says so plainly. Your diary is still useful even if nothing stands out.
• It's often a mix. The Migraine Trust says it's more likely to be a combination of several things that leads to an attack, rather than one thing.
• Some "triggers" may be early symptoms. The Migraine Trust notes that what you think is a trigger may actually be an early symptom of an attack. Craving chocolate is its example. The NHS lists early symptoms such as feeling very tired, yawning a lot, craving certain foods, mood changes and a stiff neck, starting hours or up to 2 days before the head pain.

How to track them, step by step

1. Pick a short list. Choose 5 to 8 factors you want to watch, for example sleep, meals, caffeine, alcohol, stress, your period and the weather. A short list you fill in every day beats a long one you give up on.
2. Log every day, not only attack days. If you only write things down when you have a migraine, you can't compare. A bad night's sleep before an attack means little if you sleep badly most nights.
3. Use the same words and scales. "Slept under 6 hours" is easier to compare than "slept badly" one day and "tired" the next.
4. Note the timing. Write when things happened. Something the evening before an attack is different from something the week before.
5. Write early symptoms separately. If you yawn a lot or crave sweet food before an attack, note it as a symptom too. That helps your doctor tell the two apart.
6. Keep the basics. Start time, how long it lasted, pain score, symptoms and every medicine with the dose. The printable headache diary template has a column for possible triggers next to all of these.
7. Review it with your doctor. Bring the diary to your GP or headache clinic. Let them help you decide what, if anything, to change.

What a diary can and can't tell you

A diary can show that something often came before your attacks. For example, that a lot of your attacks came after a short night. That's worth talking about. It doesn't show that the short night caused them. Both might have another reason, it might be chance, or the poor sleep might be an early sign of the attack itself.

The Migraine Trust also says focusing too much on avoiding triggers can cause more harm than good, and that there is a lack of evidence to support food triggers for migraine. So don't cut out foods or change your life on the back of a few weeks of notes. Talk to your doctor first.

Tracking possible triggers in Easing

Easing is a migraine diary for iPhone, coming soon to the App Store. When you log an episode you can tag possible triggers you noticed. If you allow it, Easing reads sleep and cycle data from Apple Health. After five episodes, Insights lines your logs up next to pressure changes, sleep, humidity and your cycle, and shows the tags you used most. That's a count of what you logged, not a finding about what causes your migraines. Easing doesn't diagnose anything. See the migraine diary app page.

Questions