Using Your Apple Watch and iPhone as a Digital Migraine Diary

A migraine attack brings pain, light and sound sensitivity, and lost hours. You remember the experience, but do you remember exactly when the attack started, whether it lasted 8 hours or 24, whether it struck on the same day of the week last time, or what came before it? Sam cannot detect or predict migraine attacks for you, but your Apple Watch and iPhone can create a reliable, time-stamped record of your migraine pattern that you and your neurologist can use.

Why your neurologist asks about migraine patterns

The International Headache Society defines a migraine attack clinically in the ICHD-3 criteria: an episode lasting 4 to 72 hours, typically affecting one side of the head, with a throbbing quality, moderate to severe intensity, worsened by routine physical activity, and accompanied by nausea and/or sensitivity to light or sound. That definition is precise, but it describes what happens during a single attack. For diagnosis and treatment planning, your neurologist needs a longer view: How often do attacks occur? How long do they last? Do certain triggers appear before each one?

Migraine diaries are standard practice in neurology. The German Migraine and Headache Society (DMKG) and the German Society of Neurology (DGN) recommend regular migraine tracking as part of both initial diagnosis and ongoing treatment monitoring. A neurologist cannot see your attacks directly; they depend on your account of frequency, duration, severity, associated symptoms, and potential triggers. A digital diary creates a clear record and gives your doctor the concrete data they need.

Setting up Apple Health for migraine tracking

Apple Health does not have a pre-built "Migraine" template, but you can create one in seconds. On your iPhone, open the Health app and navigate to Health Data. Tap the "+" symbol and select "Symptom" or "Other" (depending on your iOS version). Name the new symptom "Migraine" or "Migraine Attack." You can then set it to record binary presence (yes/no) or, preferably, add custom fields: start time, end time, severity (scale of 1-10), location (unilateral or bilateral), and associated symptoms (nausea, photophobia, phonophobia, or other details relevant to your attacks).

Alternatively, you can use the Symptoms category in Health to log "Headache" with severity and add notes in the Health app's Notes feature to capture details. Many people use a combination: the Health app for quick logging and a Notes entry for the full story. Some prefer a third-party app like Apple's Reminders or a note-taking app for a structured template, then sync the summary back to Health. The key is consistency. Choose a method you will use every time an attack ends.

Once set up, each entry automatically time-stamps itself and syncs across your devices. Apple Health then serves as your central repository, visible to any health app (including Sam) that reads from Apple Health with permission.

What to track and why each detail matters

Start and end times establish attack duration, which is part of the ICHD-3 definition and affects treatment decisions. An attack lasting 6 hours is different from one lasting 20 hours. Your watch's clock is exact.

Severity (1-10 scale) is subjective, but consistency matters. A "7 this time, 6 last time" trend tells your neurologist whether your attacks are stable, worsening, or improving, which informs whether a current treatment is working or needs adjustment.

Location (unilateral vs. bilateral, front vs. back) can indicate trigger patterns. Some people's migraines always start on the right side; others alternate. Some attacks cluster toward the front of the head; others are diffuse. Over time, you may notice your attacks have a signature location, or that a different location signals a different trigger.

Associated symptoms refine the diagnosis. Nausea and light sensitivity are part of the ICHD-3 definition. Aura (visual disturbances, tingling) is a subtype that has its own clinical name and sometimes different treatment options. Dizziness, difficulty concentrating, or other symptoms narrow the differential diagnosis.

Well-documented migraine triggers include:

• Irregular sleep: both too little sleep and sleeping too much (weekend oversleep is a classic trigger for many)
• Stress and "let-down" after stress: the relaxation phase after a stressful event, not always the stress itself
• Skipped meals or dehydration: common in busy schedules
• Hormonal fluctuations: for menstruating individuals, attacks often cluster around menses or ovulation
• Alcohol: especially red wine, in some people
• Weather changes: scientifically debated as a universal trigger, but real for many individuals

This is where sleep, resting heart rate, and migraine data becomes relevant. Your Apple Watch records your sleep duration, sleep variability, and resting heart rate every night. Irregular sleep patterns and elevated resting heart rate can both precede migraine attacks. By reviewing your migraine diary alongside your Apple Health sleep and heart-rate trends, you can identify whether sleep disruption or physiological stress consistently appears before your attacks.

A regular sleep-wake rhythm (going to bed and waking at roughly the same time each day) is a non-drug measure recommended by neurologists specifically to reduce migraine frequency. If your data shows a pattern (attack follows late bedtime or fragmented sleep), that insight helps you and your doctor decide whether sleep scheduling is worth working on.

Where Sam Health fits in

Sam reads sleep, resting heart rate, and stress data from Apple Health and shows you your personal baseline across weeks and months. Once a month, Sam automatically compiles this into a PDF report you can bring straight to your appointment, with no manual exporting or screenshotting needed. When you log a migraine attack in Apple Health, Sam can display it alongside your sleep and heart-rate trends, so you can visually compare: "Was my sleep disrupted that night? Was my heart rate elevated? Was I in a stress peak?" This is not a diagnosis or prediction. Sam cannot tell you an attack is coming. But it can organize the data you are already collecting, making it easier to identify your own patterns.

Sam is a wellness companion, not a medical device. Sam does not diagnose, treat, or prevent any illness and does not replace medical advice. For health questions, always consult a qualified medical professional. Sam does not detect or predict migraine attacks directly.

When you bring your Apple Health migraine diary to your neurologist, your doctor interprets the patterns and decides on next steps. Your role is to record accurately. Your doctor's role is to distinguish real triggers from coincidences and guide treatment.

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Sources

• International Headache Society (IHS): ICHD-3 Criteria - Migraine - the clinical definition standard used worldwide for migraine diagnosis
• Deutsche Migräne- und Kopfschmerzgesellschaft (DMKG): Leitlinien zur Migräne - German guidance on migraine management and monitoring
• German Society of Neurology (DGN): S1-Leitlinie Migräne - German neurology society guidelines for migraine diagnosis and tracking
• American Migraine Foundation: Migraine Diary Guide - practical advice on keeping a migraine diary for clinical use