If you've been told to keep a migraine diary, the instruction usually arrives with no template and a follow-up appointment months away. Here is what the diary is actually for, so you can keep the right one. A neurologist needs three numbers a month — how many days you had a headache, how many of those were migraine, and how many days you took something for it — because the definitions of chronic migraine and medication-overuse headache are written in those units, and so is eligibility for most preventive treatments. Everything else you record is there to find your pattern, and it can be short. This guide covers what to log for every attack, what to note on the days you feel fine, how long before the diary means anything, and what to bring to the appointment. There's a free template you can copy at the end.
Why your neurologist asked for one
Memory is a bad instrument for headaches. People asked "how many migraines a month?" round to a number that sounds reasonable, forget the mild ones, and merge two attacks that ran into each other. Clinicians know this, which is why the diagnostic criteria are built to be counted prospectively rather than recalled. Under the International Classification of Headache Disorders (ICHD-3), the current standard:
- Chronic migraine is headache on 15 or more days a month for more than three months, with migraine features on at least 8 of those days. Below that, it's episodic. The line decides which preventives you're a candidate for.
- Medication-overuse headache is a headache that gets worse because of the treatment, and it's defined by counting days: regular use for more than three months on 10 or more days a month of triptans, ergotamines, opioids or combination painkillers, or 15 or more days a month of simple painkillers such as paracetamol or NSAIDs. Most people crossing that line have no idea they have, because nobody counts.
- Menstrual migraine is a pattern, not a feeling: attacks landing in the window from two days before to three days into a period, in at least two out of three cycles. You can only see that with dated entries across several months.
None of these can be established from a conversation. The diary is the test. That's also why "I tracked for a week and it didn't show anything" is not a failure — a week can't show what the definitions are asking about.
What to record for every attack
Record the core fields on every attack without exception, and the optional ones when you can. The core takes under a minute.
| Field | Why it matters | Core or optional |
|---|---|---|
| Date and start time | Produces the headache-day count; start time reveals patterns (on waking, mid-afternoon, post-work) | Core |
| End time | Duration separates migraine (typically 4–72 hours untreated) from other headache types, and shows whether treatment shortened it | Core |
| Pain 0–10 at its worst | Lets you and the clinician see whether attacks are getting milder or worse over months, which is how preventives are judged | Core |
| Aura: yes or no | Migraine with aura is classified separately and changes some treatment choices (notably around estrogen-containing contraception) | Core |
| Medication: what, dose, time, did it work | Produces the medication-day count, and "did it work" is the only evidence for whether to change the acute treatment | Core |
| Main symptoms | Nausea, light/sound sensitivity, one-sided, throbbing, worse on movement — these are the migraine features the "8 of 15 days" rule counts | Optional |
| Menstrual cycle day | The only way to confirm or rule out a menstrual link | Optional (core if you menstruate) |
| One line on the day | "Slept 5h", "skipped lunch", "storm coming in", "deadline" — the raw material for trigger patterns later | Optional |
Two rules that keep this honest. Log the start when it starts, even if the entry is just a timestamp and you fill the rest in that evening — an attack recorded the next day from memory gets a softer pain score and a vaguer start time every time. And count the mild ones. A dull headache you worked through still counts as a headache day for the chronic-migraine threshold, and leaving it out is the most common way a diary undercounts.
What to record on headache-free days
Almost nothing — and that is the point. The diary that fails is the one that asks for sleep, stress, hydration, weather, meals and mood every single day; people keep it for nine days. On a clear day, record that it was clear. That single entry is what makes the headache-day count trustworthy, because it proves the blank days were logged, not skipped.
If you're deliberately testing one suspected trigger, add that one thing and nothing else: hours slept, or caffeine, or cycle day. Test one at a time for a month. If you suspect weather, the method is specific enough to have its own guide — how to track barometric pressure migraines — and a free four-box test that tells you whether your own diary supports the link.
The minimum viable diary: three numbers a month
If you keep nothing else, keep a monthly line with these three counts. They are what the first five minutes of the appointment are about.
- Headache days — any day with any headache, mild included.
- Migraine days — the subset with migraine features (one-sided, throbbing, nausea, light or sound sensitivity, worse on movement) or where you took a triptan.
- Medication days — days you took anything acute for it, with a separate count for triptans if you use them.
Three months of those lines tells a neurologist whether you're episodic or chronic, whether medication overuse is in play, and whether a preventive is working. Everything in the tables above exists to make those numbers accurate and to explain them.
How long before the diary says anything
| You want to know… | Track for at least | Why |
|---|---|---|
| A reliable headache-days-per-month figure | 1 month | Anything shorter is a guess scaled up |
| Episodic or chronic; medication overuse | 3 months | Both ICHD-3 definitions are written over "more than three months" |
| Whether a new preventive is working | 2–3 months on the dose | Preventives are judged on the change in monthly headache days, and most take weeks to act |
| A menstrual pattern | 3 cycles | The definition requires the window to hit in at least 2 of 3 cycles |
| A single suspected trigger | 1 month, one trigger at a time | Enough exposed and unexposed days to compare; more triggers at once just blur it |
If your appointment is in two weeks, don't wait — start today and bring what you have. Two weeks of same-day entries is more useful to a clinician than a confident recollection of the last year.
Paper, a notes app, or a migraine diary app?
All three work if they meet one condition: you can log the start of an attack in seconds, in the dark, with a pounding head. That rules out anything that opens with a form.
| Paper diary | Notes app | Migraine diary app | |
|---|---|---|---|
| Logging mid-attack | Only if it's beside the bed | Fast, if you keep a running note | Fast, if the app opens to a one-tap start |
| Counting the month | By hand, every month | By hand | Automatic |
| Showing the pattern | You'd redraw it | Text only | Calendar view |
| Medication-day count | By hand | By hand | Automatic if you log the med |
| Privacy | Total | Depends on the app's sync | Check whether entries leave the phone |
| Failure mode | Left at home | Never tallied | Too many fields, so you stop |
Any of the apps in our migraine tracker roundup will count the month for you. The reason we built MigrainePal is the first row: it opens to a single tap that starts an attack with the time, so you can put the phone face down and add the pain score, aura and meds when you're able. The calendar shows the month the way this page describes it — headache days, migraine days, medication taken — and the insights screen gives frequency, average pain and medication response in plain language, so there's nothing to export before the appointment. Everything stays on the device; there's no account. It's free, with an optional Premium for advanced exports and history.
What to bring to the appointment
- Headache days and migraine days per month for as many months as you have — the calendar view, or the three-number line.
- Medication days per month, with triptans counted separately if you use them.
- Every acute and preventive medication you've tried, at what dose, for how long, and what happened — the "did it work" column, summarised.
- Your two clearest patterns, if any: "almost always on waking", "cluster in the week before my period", "the day after under five hours' sleep".
- Whether attacks are getting milder, worse, or staying the same — the pain-score trend.
- Anything new: a change in the type of headache, a new symptom, a "worst ever" attack. These get asked about first and are easy to forget under pressure.
A free migraine diary template
Copy this into a notes app or print it. One block per attack; one line per clear day.
ATTACK Date: ____ Start: __:__ End: __:__ Worst pain (0–10): __ Aura: Y / N Symptoms: nausea / light / sound / one-sided / throbbing / worse on movement Took: ________ dose ____ at __:__ → helped: yes / partly / no Took: ________ dose ____ at __:__ → helped: yes / partly / no Cycle day (if applicable): __ One line on the day: ______________________________ CLEAR DAY Date: ____ Clear ✓ (test item, if any: ______) MONTH TOTALS Headache days: __ Migraine days: __ Medication days: __ (triptan days: __)
Frequently asked questions
What should I record in a migraine diary?
For every attack: the date, when it started and when it ended, pain on a 0–10 scale, whether there was aura, and every medication you took with the time and whether it worked. That is the core, and it is enough to produce the numbers a neurologist uses. If you can manage more, add the main symptoms (nausea, light or sound sensitivity, one-sided), where you were in your menstrual cycle if that applies, and one line on what was going on that day. On headache-free days record only that the day was clear, plus anything you are deliberately testing, such as sleep hours or caffeine.
How long should I keep a migraine diary before seeing a neurologist?
One full month is the minimum that produces a meaningful headache-day count, and three months is what the diagnostic thresholds are written against — chronic migraine and medication-overuse headache are both defined over more than three months. If the appointment is sooner than that, bring whatever you have; two weeks of honest entries beats three months of guessing. For a suspected menstrual link, you need at least three cycles so the pattern can repeat.
How many headache days a month is chronic migraine?
Under the International Classification of Headache Disorders (ICHD-3), chronic migraine is headache on 15 or more days per month for more than three months, where at least 8 of those days have migraine features. Below that it is episodic migraine. The distinction matters because it changes which preventive treatments you are eligible for, and the only way to establish it is a diary that counts every headache day — including the mild ones people tend to leave out.
Is a migraine diary app better than paper?
Paper works if you carry it and fill it in the same day; its weakness is that you have to count the month up by hand and it is not with you at 3 a.m. when the attack starts. A general notes app fixes the carrying problem but not the counting. A dedicated migraine diary app does the counting for you and can show the month as a calendar, which is the view a neurologist wants. The only thing that matters is that you can log the start of an attack in seconds while it is happening — a diary you fill in the next day from memory will undercount.
A migraine diary you can start with one tap, mid-attack.
Tap once to start the attack, put the phone down, fill in the rest later. The calendar counts your headache, migraine and medication days for you. No account, nothing leaves your phone.
Download MigrainePal on the App Store →Related: The Best Migraine Tracker Apps and How to Track Barometric Pressure Migraines. Diagnostic thresholds are quoted from ICHD-3 for orientation only; this is not medical advice, and a diary is something you bring to a clinician, not a substitute for one. Questions? Email us.