New to migraine: what happens in the first weeks, what your doctor checks and what to write down
Migraine diagnosed, what now? What your doctor checks next, what to record in the first four weeks and which questions to bring.
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After a migraine diagnosis you can start a headache diary and collect questions for your next appointment. That works on paper or in Sam, where sleep and heart rate variability from Apple Health sit next to every entry. What happens medically next is decided by your doctor.
Four weeks of diary give you two numbers that make the conversation concrete. This text covers what to record, what doctors usually check and what the sources say about "curable" and "inherited". It is for you if a doctor has already diagnosed migraine. If you only suspect it, book an appointment first. The criteria are in our comparison of migraine and tension headache.
What do doctors mean by migraine?
The NHS describes migraine as a throbbing headache, often on one side, usually with nausea and sensitivity to light. Some people get an aura first, such as zigzag lines or flashing lights.
Doctors work from the ICHD-3 criteria. For migraine without aura they ask for at least five attacks that last 4 to 72 hours untreated. The pain has at least two of four features: one-sided, pulsating, moderate or severe, and worse with routine activity such as climbing stairs. During the headache you have nausea or vomiting, or you are sensitive to both light and sound. Another diagnosis must not explain it better.
These criteria are for clinicians. They are not a self-test. Your doctor decides whether they fit you.
What does my doctor check next?
The American Migraine Foundation says there is no test that proves migraine. Your doctor takes your symptoms and your personal and family history and examines you. An MRI or CT may be ordered to rule out other causes.
Expect questions like these:
- How do the headaches feel?
- Where are they and since when?
- Have you had them before?
- Do other symptoms come with them?
- Which medicines do you take, how often and since when?
The NHS advises seeing a GP if attacks are severe, frequent or hard to control. Who looks after you from here on is agreed between you and your doctor.
What do I write down in the first four weeks?
The Migraine Trust suggests keeping a diary simple. It helps your doctor make a diagnosis, shows patterns and shows whether your medicine works. A paper template is fine, and you can start today.
These details are a good start for each attack:
- Date and time it began.
- Strength, on one scale you do not change.
- How long it lasted.
- Other symptoms: nausea, sensitivity to light or sound, one-sided pain.
- Aura: yes or no.
- Any medicine you took for the attack.
- A note on sleep, food, stress or anything unusual.
In Sam's migraine program the entry holds these fields: start, strength in three levels, duration in steps, accompanying symptoms, aura and a note. There is no field for medication; if you like, write it in the note. An entry takes about 30 seconds. For entries made today, sleep and heart rate variability come from Apple Health. You add only what you know yourself.
Enter attacks the same day, not on Sunday for the whole week. Note headache-free days too. For more on triggers, see migraine triggers: sleep, stress and patterns.
Which two numbers come out of the diary?
Two numbers can be read from a diary: on how many days a month you had an attack, and on how many days you took acute medication. Sam counts the migraine days. The medication days you can write in the free-text note if you wish, or keep a tally on paper, and your doctor assesses the number.
Here is an example with invented numbers. After four weeks your paper calendar says "five migraine days, three of them with acute medication". That is two sentences your doctor can work with. What they mean for you is for your treatment team to interpret.
The NHS advises not taking painkillers on more than 2 days a week, because that can cause more headaches and make migraine harder to treat. That is one reason doctors ask for the second number.
The MIDAS questionnaire adds a third view. It asks on how many days in the last three months migraine limited your work, household or leisure. The score describes the effect on daily life, not a diagnosis. You can fill it in with the MIDAS migraine score tool and bring the result. The paper behind it is Stewart et al., Neurology 2001.
Is migraine curable? Is it inherited?
These are the two questions most people ask first.
On cure, the NHS is plain: migraine cannot be cured, but treatment can help. Most people find attacks slowly get better as they get older. In women, migraine often improves after the menopause. None of this says how your own course will go.
On heredity, the NHS says you are more likely to get migraine if a close relative has it, and that the cause is not known. Write down who in your family has migraine.
"Chronic" has a narrower meaning in the classification than in daily speech. It means headache on at least 15 days a month. Our post on chronic migraine and how many days count explains the difference.
Which questions do I bring to the next appointment?
What you think of in the car park is missing in the room. Write your questions down before you go:
- Which form of migraine was diagnosed, with or without aura?
- Was anything else ruled out, or are more checks planned?
- Which details from my diary do you need, and for how long should I keep it?
- Which medicines are planned, and what should I note about them?
- When should I contact you before the next appointment?
- Are there patient groups or support lines you recommend?
- When is the next appointment?
Bring your diary, test results and letters, and a list of everything you take, including pharmacy products. Our checklist for a doctor visit with a chronic condition covers the rest.
What can an Apple Watch add?
The Apple Watch can record your sleep and track heart rate variability (HRV). Both land in Apple Health and are context for your diary, not a finding. In Sam they appear next to new entries. You log the attack yourself. To connect the watch, see Apple Watch migraine tracker: digital diary setup.
When should I not wait for the appointment?
A headache that starts suddenly and is extremely painful needs urgent help. So do a headache with weakness on one side, slurred speech, vision loss, confusion, a seizure or a rash that does not fade under a glass. The NHS advises calling the emergency number for these. Use your local emergency number (112 in the EU, 999 in the UK, 911 in the US). You do not have to decide whether it is an aura or something else. Sudden weakness, speech trouble or vision problems are stroke signs for the NHS, even if you know migraine with aura. This text does not replace a medical assessment.
Log migraine attacks in Sam and take them to your appointment
You bring your migraine days as a record from the migraine program.
- Instead of paper or a notes app: each attack is an entry in about 30 seconds, and sleep and HRV come from Apple Health for entries made today.
- Instead of memory: the doctor report (PDF) counts migraine days for 1, 3, 6 or 12 months or your whole record.
- Instead of Apple Health alone: the values sit next to your own entry.
- Instead of MIDAS from memory: once a month you fill in the MIDAS questionnaire as a short check-in, and the course appears in the report.
Sam records what you enter, and the program starts after a doctor has diagnosed migraine.
Try Sam HealthSam is a wellness companion, not a medical device. The app does not diagnose, treat, cure or prevent any condition or health state. Always consult qualified professionals for medical decisions.
Related reading
- Migraine vs. tension headache: key differences
- Chronic migraine: how many days count
- Sam symptom diary for headaches that are not migraine
Sources
Updated: October 2026
- NHS: Migraine and Migraine treatment (page last reviewed 10 March 2026)
- NHS: Headaches (page last reviewed 17 April 2024)
- NHS: Stroke symptoms
- American Migraine Foundation: Migraine diagnosis and treatment
- The Migraine Trust: Keeping a headache diary
- International Headache Society: ICHD-3, 1.1 Migraine without aura and 1.3 Chronic migraine
- Stewart WF et al.: Development and testing of the Migraine Disability Assessment (MIDAS) Questionnaire to assess headache-related disability. Neurology 2001;56(Suppl 1):S20-S28, PubMed 11294956
More on Migraine
Frequently Asked Questions
Which doctor is responsible for a migraine diagnosis?+
For most people the first stop is the GP or family doctor. The NHS advises seeing a GP if attacks are severe, frequent or hard to control. The American Migraine Foundation says there is no single test: the doctor takes your history, examines you and sometimes orders an MRI or CT to rule out other causes. Who treats you afterwards is something you agree with your doctor.
When do doctors call it migraine?+
The International Classification of Headache Disorders (ICHD-3) asks for at least five attacks lasting 4 to 72 hours. The pain has at least two of four features: one-sided, pulsating, moderate or severe, worse with routine activity. It comes with nausea or vomiting, or with sensitivity to light and sound. Another diagnosis must not fit better. Whether this applies to you is your doctor's call.
What happens at a neurologist appointment for migraine?+
Mostly a detailed conversation about your headaches: how they feel, where, since when, and which medicines you take. A physical examination follows. The American Migraine Foundation says scans such as MRI or CT may be ordered to rule out other causes. Which checks you need is your doctor's decision.
Can migraine be cured?+
The NHS says migraine cannot be cured, but treatment can help manage attacks and prevent them. It also says most people find attacks slowly get better with age, and in women often after the menopause. What that means for you is something only your doctor can say.
Does migraine run in families?+
The NHS says you are more likely to get migraine if a close family member has it, and that the cause is not known. Write down who in your family has migraine and tell your doctor.
How many migraine attacks a month are normal?+
The sources used here give no normal value. Some people have an attack now and then, others lose several days every month. Your own number is what counts. After four weeks of a headache diary you have a first one.
How long should I keep a headache diary?+
The International Headache Society says frequent headaches generally need a diary kept day by day for at least a month. Ask your doctor how long they want it. Include days without headache, so an empty day is not mistaken for a forgotten one.
What can an Apple Watch do for migraine?+
It can record your sleep at night and track heart rate variability. Both land in Apple Health as background for your diary, and in Sam they appear next to new entries. You log the attack yourself. A watch does not diagnose migraine.