Migraine trigger tracking and when to consider preventive medication

I didn’t set out to become “the person with the headache spreadsheet,” but here we are. After a run of unpredictable migraines that kept hijacking birthdays, workouts, even a regular Tuesday, I started tracking triggers the way you’d track spending: small, honest entries that reveal patterns you simply can’t see in the moment. The surprise was how calming it felt. Instead of guessing, I could run mini-experiments in my own life. And somewhere between the twelfth entry and the fiftieth, I also realized there’s a point where tracking and acute fixes aren’t enough—where it may be time to talk seriously about preventive medication. Today I’m writing down what I learned, both as a diary of the process and as a practical map you can adapt.

The day patterns emerged and my decisions got easier

My first aha wasn’t dramatic. I noticed that the worst weeks lined up with three things: a janky sleep schedule, a skipped lunch after a heavy morning coffee, and a particular kind of LED lighting at the gym. What convinced me these weren’t random was seeing them cluster on the same days—then seeing migraines follow 12–36 hours later. Classic triggers like disrupted sleep, stress swings, certain foods, bright or flickering light, and hormonal shifts are well described in patient education materials (see a simple overview from MedlinePlus). The key for me wasn’t memorizing a list; it was catching my personal stack of triggers that had to pile up before an attack.

  • High-value takeaway: Triggers often act in combination. One coffee won’t topple you; one coffee after a short night under harsh lighting might.
  • I made a lightweight log: date, hours slept, meals, hydration, caffeine, stress (1–5), period phase (if relevant), exposure to bright/flicker light, weather swings, exercise type, and “early signals” (neck tightness, yawning, irritability).
  • Every two weeks, I scanned for repeating pairings rather than single offenders. This lowered the guilt about “bad” foods and focused me on realistic tweaks.

I also got honest about acute medicines. Triptans helped but sometimes arrived too late. I learned that frequent use of acute meds can backfire into medication-overuse headache—MOH—especially if taken on many days per month (basic definitions and cautions are summarized by NINDS). That realization nudged me toward reading about prevention rather than just firefighting each attack.

A friendly framework for tracking without obsessing

This is the approach that kept me sane and actually gave me answers.

  • Step 1 Notice the reliable early cues: my neck gets stiff on one side, I yawn a lot, and I get oddly sensitive to smells. When those show up after poor sleep or a stressful day, I flag the day in my log.
  • Step 2 Compare weeks with attacks to weeks without. Instead of demonizing one trigger, I look at combinations. Did a hard HIIT workout under bright LEDs after a chaotic morning appear in three of the last four attacks?
  • Step 3 Confirm the pattern with small tests for 2–4 weeks. For me: move HIIT outdoors or earlier in the day, cap caffeine by noon, carry a protein snack, and swap the gym area with softer lighting. Keep the log going and check whether attack frequency or intensity changes. If it doesn’t budge or I’m still using acute meds many days each month, that’s a signal to discuss prevention with a clinician (the American Headache Society has clinician-facing summaries that helped me frame that talk).

Importantly, I stopped chasing perfection. Triggers are not moral failings; they’re inputs you can dial up or down. The log is there to inform choices, not to run your life.

When my notes suggested it was time to talk prevention

I didn’t want daily pills; I wanted my life back. The turning point was a three-month stretch with 6–8 migraine days each month, plus two missed workdays and a birthday dinner derailed by nausea. My acute meds worked only part of the time, and I was starting to use them on a lot of days. That’s roughly where professional guidelines suggest considering preventive therapy—especially when there are four or more monthly migraine days with meaningful disability, or when acute medications are either overused, poorly tolerated, or contraindicated. The American Headache Society (AHS) consensus and related neurology guidance outline these decision points in plain terms (an accessible entry is the AHS consensus resources; see AHS resources and the AAN guideline library).

  • Consider prevention if: you have ≥4 migraine days per month with disability, ≥8 migraine days regardless of disability, or fewer days that are unusually severe or complicated (e.g., prolonged aura). These numbers are general waypoints—your context matters.
  • Also consider it if: you can’t use acute meds safely (cardiovascular risks with some triptans, adverse effects) or you’re sliding into MOH by needing acute meds too often.
  • Talk sooner if you notice red-flag features (sudden thunderclap headache, new neurologic deficits, fever, head injury, or a dramatic change in pattern) because those can signal something different and require medical evaluation (MedlinePlus headache overview gives simple triage cues).

When I brought my log to my visit, the conversation got concrete fast. We could see my typical week, my acute use, my missed activities. That turned a vague “I’m miserable” into a shared plan.

What prevention can look like in the real world

Preventive strategies come in flavors, and many of them can be combined. Here’s how I organized them with my clinician:

  • Lifestyle anchors that support the nervous system: regular sleep/wake times, morning light exposure, balanced meals (protein + complex carbs + hydration), and consistent exercise (not heroic spikes). It sounds basic because it is—and yet it’s a strong layer in the stack. I set two “non-negotiables”: bedtime window and water bottle at my desk.
  • Non-drug options with evidence: cognitive behavioral therapy for migraine, relaxation training, biofeedback, and some neuromodulation devices (at-home external nerve stimulation). These aren’t instant fixes, but the trajectory over months can be meaningful. A plain-English overview of non-drug tools appears in several academic and patient resources (see NINDS and educational summaries linked from AHS).
  • Prescription preventives tailored to you:
    • Traditional options used off-label or approved for migraine prevention (examples your clinician may discuss include certain beta-blockers, topiramate, tricyclics). Choice depends on your health profile and side-effect tolerance.
    • Anti-CGRP therapies (monoclonal antibodies and small-molecule antagonists) that target migraine pathways more specifically. These can be monthly, quarterly, or daily, depending on the agent. Your insurance rules and medical history will guide access and fit. The AHS consensus statements explain where these fit among options (see AHS resources).
    • OnabotulinumtoxinA injections for chronic migraine (≥15 headache days per month), administered on a schedule by trained clinicians.

I asked a simple question: “What’s our first step, and how will we judge success?” We set a trial window of 8–12 weeks for a preventive, aiming to reduce monthly migraine days by at least 30–50% and improve function. We wrote down what side effects would be unacceptable and how to taper if needed. These specifics kept me from switching too early or sticking with something that clearly wasn’t working.

The trigger log I actually use and keep using

If a tool is annoying, I abandon it. So my log is boring by design:

  • One screen on my phone with daily toggles: sleep 0–2 (poor/ok/good), caffeine amount, meals on time (yes/no), hydration (liters-ish), stress 1–5, workout type, light exposure (normal/harsh/flicker), period phase, weather change (yes/no), and early cues (neck, yawning, smell sensitivity).
  • When an attack starts, I add: time, aura (yes/no), pain side, associated symptoms (nausea, photophobia), acute med taken and timing, relief after 2 hours (yes/no), and whether I rested or kept pushing.
  • Every two weeks, I tag the top two predictable combos (e.g., poor sleep + skipped lunch + harsh light). Then I choose one combo to tackle for the next fortnight.

This rhythm—notice, compare, confirm—beats perfectionism. And it makes clinical conversations simpler because the data are already there. If you like paper more than apps, use a weekly printout and keep it on your nightstand.

How I decided between “try harder on triggers” and “start prevention”

I used a simple decision aid that I scribbled in the margins of my notebook. It’s not official, but it kept me honest:

  • Burden score: How many days per month am I losing or limping through because of migraine? What’s the hit to work, family time, and mood? Anything ≥4 days or repeated high-impact days goes in the “consider prevention” column.
  • Acute dependency check: Am I relying on quick-fix meds so often that I’m flirting with MOH territory? (As a general principle, frequent use across many days can increase risk; details vary by medication class—see MedlinePlus on MOH.)
  • Trial-and-learn honesty: Have I already tried consistent sleep, meal timing, hydration, light adjustments, and stress-management for at least a few weeks? If yes and the needle barely moved, I stop blaming myself and talk prevention.

Writing those answers down prevented the endless do-I-or-don’t-I loop. And it made the clinic visit feel collaborative rather than like a performance review of my willpower.

Red and amber flags I promised myself I wouldn’t ignore

Because the internet can be both helpful and scary, I made a non-alarmist list of symptoms that mean “don’t self-manage, get medical help.” I set a rule: if any of these show up, I pause the tracking mindset and seek care.

  • Red flags: sudden “worst headache of my life,” new neurologic deficits (weakness, speech trouble, vision loss beyond typical aura), fever with stiff neck, head injury, or a major change in headache pattern. These warrant prompt medical evaluation. See MedlinePlus for a plain summary of when to get help.
  • Amber flags: attacks getting more frequent despite consistent habits, acute meds needed on many days, or new side effects. These are “call your clinician soon” signs.
  • Paperwork flags: If insurance or pharmacy rules complicate access to preventives, I ask about alternatives, prior authorization, or patient-assistance programs rather than giving up. AHS patient resources sometimes link to practical help.

What actually changed after I started prevention

Here’s the honest part: prevention didn’t erase migraine, but it shaved off the sharpest edges. Three months in, I was down from 7–8 migraine days to about 3–4, and the “lost the whole day” episodes were rarer. The trigger log didn’t go away; it got simpler. I still watch sleep, meals, and light exposure, but I’m less brittle—my system can tolerate a missed snack without spiraling. I also realized that preventive success can mean better response to acute meds, fewer side effects from chasing attacks, and more predictable weeks. That predictability is worth a lot.

Small habits that compounded better than any single hack

  • Morning light + consistent bedtime: I set a weekday alarm for getting sunlight and a dimming routine at night. This stabilized both sleep and mood.
  • Protein first, coffee second: Adding a quick breakfast before caffeine cut down that mid-morning crash that often preceded attacks.
  • Light-smart workouts: I moved intense sessions to spaces with steady, non-flicker lighting or daylight. On “amber” days, I swapped to a walk or gentle strength work.
  • Calendar guardrails: I add “buffer blocks” before big events. Fewer stacked stressors = fewer three-trigger days.
  • Pre-packed acute kit: Hydration packet, sunglasses, soft earplugs, and my prescribed acute med with written timing instructions so I don’t delay.

Talking with a clinician without feeling rushed

My best visit happened when I arrived with a one-page summary. If you want a template, here’s mine:

  • Monthly snapshot: average migraine days, days I used acute meds, top two trigger combos, and how many activities I skipped.
  • What I tried: changes to sleep, food, light, exercise; any supplements; any device.
  • Goals: “Cut monthly migraine days in half,” “Make acute meds work within 2 hours most of the time,” “Reduce work disruption.”
  • Constraints: other health issues, pregnancy plans, sensitivities, or insurance limits.

Having this made the treatment plan feel like co-design. We discussed options grounded in guidelines (AHS and the American Academy of Neurology maintain up-to-date resources: AHS, AAN), and we wrote down what to expect over the next few months.

What I’m keeping and what I’m letting go

I’m keeping the log, but I’m letting go of perfection. I’m keeping the morning light, the protein-first rule, and the respectful boundaries around stress. I’m letting go of the story that “if I just worked harder on triggers, I wouldn’t need prevention.” Sometimes the most compassionate move is to add a preventive layer so your life can breathe. Two principles I bookmarked:

  • Principle 1: Track to learn, not to police yourself. Patterns are tools, not verdicts.
  • Principle 2: Consider prevention when burden stays high despite consistent habits or when acute meds start running the show.
  • Principle 3: Iterate with timeboxed trials and clear success criteria. If a plan isn’t helping after a fair trial, it’s information—not failure.

If you want to go deeper, the resources below are trustworthy starting points. I use them to sanity-check claims and to prepare questions before appointments.

FAQ

1) How many migraine days mean I should consider preventive meds?
Answer: Many clinicians start the conversation at around four or more migraine days per month with disability, or sooner if attacks are severe, prolonged, or your acute meds are overused or poorly tolerated. It’s a shared decision tailored to your health profile; use your log to guide it.

2) Can I try non-drug prevention first?
Answer: Absolutely. Regular sleep, meal timing, exercise, stress skills, and certain behavioral therapies can lower frequency or intensity for many people. Neuromodulation devices are another option. If burden remains high, combining these with prescription prevention is common.

3) What about side effects of preventives?
Answer: It depends on the medication class. Traditional options and newer CGRP-targeting therapies have different profiles. Discuss what matters most to you (fatigue, weight change, mood, cardiovascular considerations), and set a trial window (often 8–12 weeks) to review benefits and tolerability.

4) How do I avoid medication-overuse headache?
Answer: Work with your clinician on a plan that limits frequent use of acute meds and pairs them with prevention if needed. Early treatment in the attack plus prevention to reduce total attacks can help. A plain overview of MOH is available on MedlinePlus.

5) Do hormones and menstrual cycles change the plan?
Answer: They can. Some people have perimenstrual migraine patterns; strategies may include cycle-aware acute timing, lifestyle adjustments around vulnerable days, or targeted preventive approaches. Bring cycle notes from your log to your clinician to tailor options safely.

Sources & References

This blog is a personal journal and for general information only. It is not a substitute for professional medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Always seek the advice of a licensed clinician for questions about your health. If you may be experiencing an emergency, call your local emergency number immediately (e.g., 911 [US], 119).