Once you've tracked your headaches, some trends should start to emerge, both in the nature of your headaches and the circumstances that surround them. The length and progression of your headache may be similar in pattern. Prodromal symptoms that occur prior to a migraine headache, such as anxiety and fatigue, may become apparent and could be reliable cues that you can use to anticipate migraine episodes.
You may notice that your headaches are happening at a certain time of day, when you encounter sensory stimuli such as flashing lights, or after you have certain foods or beverages. The location and severity of the head pain may be consistent. All of these things are important clues to a proper diagnosis.
Migraines often follow these patterns:
One-sided, pulsating pain that tends to get worse with physical exertion
A duration from four hours to three days
Accompanied by nausea and vomiting
Are alleviated by rest in a dark, quiet room
May be followed by a period of mental confusion and sensory sensitivity
Identifying migraine triggers is one of the most important parts of evaluating your headache diary. Since a substantial part of effective migraine treatment is avoiding known triggers, pinpointing them is critical. When something occurs in your environment two or more times prior to a headache episode, it should be considered a suspected migraine trigger. Chapter 6 explores migraine triggers in depth, but the following broad trigger categories are things you should look for as you analyze your headache diary.
Foods. Because most people eat a mixed meal consisting of several foods at mealtimes, foods may take a little longer to identify as triggers. Do some detective work by reading nutritional facts labels and looking for known migraine culprits (see Chapter 17 for more on food triggers).
Beverages. This includes alcohol and caffeine-containing beverages. Caffeine can both cause and soothe headache depending on the amount and frequency of its use, so it's an important element to look for when evaluating your diary.
Sensory stimulants. Lights, sounds, and smells are all potential triggers.
Lifestyle factors. High-stress situations, changes in regular routine, disruption of normal sleep schedules, and secondhand smoke are all lifestyle factors that can lead to a migraine.