What should I record in a headache diary if I have migraine with aura?

Record each aura symptom (visual, sensory, speech or language), when it started, how it developed and how long it lasted, then when the headache began relative to the aura. ICHD-3 notes that people often find it hard to describe their aura and should time and record it as it happens; only a doctor can tell whether it is migraine aura.

Facts checked on · Written by Alfonso Matos, the developer of MyGrain.

Which aura details matter

ICHD-3 describes aura as fully reversible visual, sensory, speech and/or language, motor, brainstem or retinal symptoms. Visual aura is the most common, occurring in over 90% of people with migraine with aura at least in some attacks. It often looks like a zigzag figure that gradually spreads, sometimes leaving a blind spot. Sensory aura is next in frequency: pins and needles that move slowly and may be followed by numbness. Speech disturbances are less frequent. NICE gives similar examples: flickering lights, spots or lines, partial loss of vision, numbness or pins and needles, and speech disturbance.

Timing: how long, how fast, in what order

Timing is part of the ICHD-3 criteria. The criteria include at least one aura symptom that spreads gradually over 5 minutes or more, symptoms that occur in succession, and each individual symptom lasting 5 to 60 minutes. NICE gives the same range: aura symptoms develop over at least 5 minutes and last 5 to 60 minutes. ICHD-3 adds that motor symptoms can last up to 72 hours and that aura symptoms usually follow one another, most often visual first, then sensory, then speech.

  • Start time and end time of each symptom, not only of the whole episode.
  • Order in which the symptoms appeared.
  • Which side of the body or of your vision was affected, and whether it changed.
  • Headache: whether it came with the aura, within 60 minutes after it, later, or not at all.

Why writing it down helps

ICHD-3 says that patients often find it hard to describe their aura, in which case they should be instructed to time and record it prospectively. It lists common mistakes in reports: lateralization, sudden rather than gradual onset, one eye versus the same side of both eyes, duration, and mistaking sensory loss for weakness. It also notes that after an initial consultation, an aura diary may clarify the diagnosis. Aura can occur with or without headache, so also log the episodes in which only the aura appeared.

The rest of the entry

NICE says that a headache diary should include the frequency, duration and severity of headaches, any associated symptoms, all prescribed and over-the-counter medications taken to relieve them, and possible precipitants. In MyGrain you can log each episode with its type, intensity, duration, symptoms and treatments, and take that record to your appointment. MyGrain does not diagnose; only a doctor can diagnose.

Frequently asked questions

How long does a migraine aura last?

ICHD-3 criteria describe each individual aura symptom as lasting 5 to 60 minutes, and NICE gives the same range. Motor symptoms can last up to 72 hours, according to ICHD-3.

Does the headache always follow the aura?

No. ICHD-3 says the aura usually occurs before the headache but may begin after the headache has started or continue into it, and that aura may occur without any headache. One criterion is that the aura is accompanied, or followed within 60 minutes, by headache.

What is the most common type of aura?

Visual aura. ICHD-3 reports it in over 90% of people with migraine with aura, at least in some attacks, followed by sensory disturbances and then speech disturbances.

Should I log attacks with no aura too?

Yes. ICHD-3 notes that many people who have attacks with aura also have attacks without aura, and that such attacks are coded as both migraine with aura and migraine without aura. Record both kinds of attack.

Sources

Classification criteria and NICE guideline, re-read on .

Medical disclaimer. MyGrain is a self-tracking diary, not a medical device. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your doctor or another qualified health professional with any question about a medical condition.
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