When should I go to hospital for a migraine? Can a headache diary help identify migraine triggers?

The practical question is not simply whether the pain feels severe. It is whether this attack has features that could point to something other than a usual migraine. Migraine commonly causes a throbbing headache, nausea or vomiting, and sensitivity to light or sound. Some people have an aura such as flashing lights, tingling, dizziness or difficulty speaking. Those features may be part of migraine for someone who has had them assessed before, but a first episode or a different pattern deserves medical attention rather than a guess based on a checklist [1].

If symptoms are sudden, unfamiliar or escalating, prioritise safety over completing a diary entry, resting in a dark room, or arranging a complementary consultation. A record can be completed later. If you are unsure whether a symptom is new or whether it represents your recognised migraine pattern, seek urgent clinical advice. The separate guide to migraine red flags can help frame the warning signs, but it cannot assess you at a distance.

For non-emergency, recurring headaches, a diary turns a vague memory into useful clinical information. It can show how often attacks occur, how long they last, what symptoms travel with them, whether everyday activity is avoided, and which treatments were tried. It also gives space to record the impact that is easy to forget after the pain settles: a missed class, a screen you could not tolerate, a meeting left early, or a day spent in a dark room. This is different from searching for one culprit after every attack.

Use the diary consistently enough to see repetition. NICE advises recording frequency, duration and severity, associated symptoms, all prescribed and over-the-counter medicines, possible precipitants, and the relationship to menstruation where relevant; its diagnostic recommendation specifies at least eight weeks when a diary is used [2]. The page on how long does a migraine last gives additional context for discussing duration, but a diary should record your own timing rather than force an attack into a standard template.

Bring the diary, a complete medicine list and a short account of what you need help with. Some people want faster relief during attacks; others want fewer attacks, less uncertainty about aura, or a plan that fits menstrual timing, work and family life. Say which problem is most disruptive. This helps a doctor or other clinician decide whether review of acute treatment, prevention, referral, or further assessment is appropriate. It also keeps emergency warning signs separate from longer-term migraine management.