All migraine patients should keep a headache diary, as "an indispensable tool in their care", according to the Migraine Association of Ireland (MAI).

In a statement published this month, the MAI outlined advice from Dr. Eddie O’Sullivan, director of the Migraine Clinic, Cork University Hospital, on how keeping a record of migraines can empower patients to regain control over their lives.

Migraine is a disabling neurological disorder manifested by recurrent attacks of severe headaches with accompanying symptoms. It is ranked as the 2nd cause of disability globally by the World Health Organisation.

It is ranked as the 1st cause amongst women, as it has the highest impact in women and those aged 50+ where demands on time are at their highest in terms of career, family commitments and responsibilities. Migraine is very much an individual disorder and the subtleties of presentation and management range widely from one person to the next.

According to the advice from Dr. O'Sullivan, headache diaries are an enabling and empowerment tool which facilitates individuals to achieve their goals in migraine management. They can also serve as a useful resource for patient’s doctors, and should map out in detail a patient’s progress, providing insight into the effectiveness of treatments prescribed and recommendations given.

"Treatment decisions, changes and advice are followed with scrutiny," says Dr. O'Sullivan. "The on-going monitoring and insight maximizes care and ultimately helps individuals to achieve their goals in the management of their migraine."

The values of maintaining a migraine diary for patients include:

• The frequency of migraine attacks varies, and an accurate diary provides insight into the frequency, severity, and duration of attacks. This helps to identify trigger factors for certain individual attacks which can help reduce the frequency.
• Over time patients may take a variety of different acute therapies to manage their migraine. Recording essential data such as the efficacy, speed of onset and side effects empowers individuals to identify what works best for them.
• Medication-overuse can be a risk in patients who get frequent migraine attacks, and patients are generally advised to limit their use to 10 days per month. The diary enables careful monitoring of acute therapy usage, particularly the triptans and codeine-based products, there by mitigating against their over-usage and dependence.
• Preventative therapies are increasingly being prescribed and are indicated in patients who experience more than 2-4 attacks per month. These medications need to be monitored in the weeks and months following commencement, recording any reductions in the frequency, severity, and duration of attacks, and noting any side effects that may be experienced. For such patients, accurate headache diaries are a mandatory requirement.
• Other usage of the diary should include the noting of any non-drug management benefits of treatments such as physiotherapy, acupuncture, relaxation therapies, and stress management.

The Migraine Association of Ireland, formed in 1994, aims to assist, support, and represent people living with migraine and other headache disorders, while raising awareness of the nature of these conditions. Their services include an Information Line, quarterly newsletter, free events monthly, self-help groups and workshops, training for health professionals and patient advocacy, which can all be availed of through their website migraine.ie.