Migraine - Triggers and Headache Diary

What are migraine triggers?

Most migraine attacks occur for no apparent reason. However, something may trigger migraine attacks in some people. Triggers can be all sorts of things. For example:

• Diet and foods. For example, dieting too fast, cheese, chocolate, red wines, citrus fruits, and foods containing tyramine (a food additive).
• Environmental. For example, smoking and smoky rooms, glaring light, VDU screens or flickering TV sets, loud noises, strong smells.
• Psychological. Depression, anxiety, anger, tiredness, etc. In some people migraines occur when relaxing following periods of stress. (For example, during weekends or holidays.)
• Medicines. For example, hormone replacement therapy (HRT), some sleeping tablets, and the contraceptive pill.
• Change in habits. For example, a change in sleep patterns (missing sleep, lying in, etc), missing meals, long distance travel, jet lag, etc.
• Other. Periods (menstruation), shift work, the menopause.

Some notes about migraine and triggers

It may help to keep a migraine diary (see below). A pattern may emerge, and it may be possible to avoid one or more things that may trigger your migraine attacks. (But note: too much effort trying to identify triggers can cause some people to become anxious. In some cases it may do more harm than good to search for triggers, especially if no trigger is found - which is common.)

Many people blame foods as triggers. However, foods are not thought to be common triggers. Suspect a food as a trigger if a migraine occurs within six hours of eating it, if a migraine often occurs after eating the suspected food, and cutting out the food reduces the number of migraines.

Some people need a combination of triggers to trigger a migraine. For example, some women may only get a migraine if they drink red wine and are having a period. Another example is that a food trigger may only trigger a migraine if you are also over-tired, or stressed.

Migraine diary

An example of a migraine diary is below. It may help to fill it in over the next 3-4 months so that you and your doctor develop a better understanding of your migraine. There are two parts:

Firstly, fill in the calender part. This gives an overall picture of when the migraines occur.

• Fill in the days of the month.
• Mark when you have an 'attack'. Note: people with migraine can also have common tension-type headaches. So, in the 'attack' column, indicate when you have a migraine, or a tension-type headache, or if you are not sure.
• If you are a woman and have periods, put a B in the period column on the days you are bleeding.

Then, fill in a 'notes section' for each attack. This gives details of how bad the attacks are, how well medication helps, and possible factors that may have triggered the migraine attack.

Migraine / Headache Diary

Please describe each attack in more detail below.

Notes on each migraine / headache attack

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Date of Attack ..........        Time Started ..........        Time Finished ..........        Aura - yes | no

Severity - severe | moderate | mild     Time needed off school, work or other activities - yes | no

Other Symptoms:   Feeling Sick - yes | no      Vomiting - yes | no      Other:

Medication                    Dose       Time Taken       Relief - yes/partial/no       Time to Relief

1.
2.
3.

Possible triggers, and food and drink taken 6-8 hours before attack:

Further sources of help and information

Migraine Action  Tel: 01536 461333   Web: www.migraine.org.uk

Migraine Trust  Tel: 020 7436 1336   Web: www.migrainetrust.org

© EMIS and PIP 2005   Updated: February 2005   Review Date: July 2006   CHIQ Accredited   PRODIGY Validated