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Doctor appointment handout

Updated and source checked

How to prepare for a migraine and brain fog appointment

Use this handout when trouble thinking happens before, during, or after migraine symptoms, or continues on headache-free days. Show the doctor the exact timing, other symptoms, medicine days, and what became harder to do.

Start here Write when headaches and thinking problems begin and end, which other symptoms occur, which medicines you use and what you cannot do safely. Bring A headache and medicine diary, every medicine and supplement, earlier reports, period dates if relevant, and three examples of work, school, home, or safety problems. Ask Ask whether the symptoms meet migraine criteria, whether medicines could be contributing and what else needs checking if thinking stays slow between headaches. Know Migraine can affect attention, word finding, reading and thinking speed. A doctor considers these symptoms alongside their timing, your other symptoms and the examination.

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Migraine and Brain Fog: Doctor Visit Checklist, a doctor appointment handout from What Is Brain Fog.
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What to explain

When thinking changes during a migraine

I have trouble thinking before, during, or after migraine symptoms, and sometimes on days without a headache. Can we check whether migraine fits, whether a medicine or frequent use of headache medicine is contributing, and whether another cause or urgent warning sign needs attention? I brought a headache and medicine diary showing when the trouble thinking starts, headache days, other symptoms, medicines, sleep, meals, periods if relevant, and what I could not do.

Questions to take in

Questions about diagnosis and treatment

  1. Do my headache, nausea, light or sound sensitivity, and temporary vision, speech, or numbness symptoms meet the criteria for migraine? Do I have migraine with aura?
  2. Does the timing of my trouble thinking fit migraine, a medicine effect, frequent use of short-term headache medicine, poor sleep, low blood pressure, low glucose, or another condition?
  3. How many headache days and short-term medicine days did I have each month? Is medication-overuse headache possible?
  4. Do any symptoms or examination findings give a clear reason for brain imaging, or would a scan be unlikely to help?
  5. Could a preventive or short-term headache medicine be worsening word finding, attention, sleep, or blood pressure? If so, what safer alternatives fit my other health needs?
  6. Should we discuss migraine prevention based on my headache days, disability, preferences, pregnancy plans, other conditions, medicine history, and access to treatment?
  7. If headaches follow periods, should I keep a diary across at least 2 menstrual cycles? Does migraine with aura change my contraceptive safety discussion?
  8. If trouble thinking continues on headache-free days, which sleep, blood, thyroid, iron, vitamin B12, blood-pressure, heart, eye, head-injury, seizure, or mental-health question should we check next?

Tests and questionnaires

Headache impact, medicines and the need for imaging

MIDAS and HIT-6 measure disability or impact. They do not diagnose migraine. Brain MRI is chosen for a clear warning sign or examination finding, not for every stable migraine. A medicine review checks whether treatment may be making trouble thinking worse.

MIDAS (Migraine Disability Assessment)

MIDAS counts headache-related days lost or reduced over the previous three months. Use the adult form only for adults. Keep headache days and medicine days beside the score.

Read the test guide

HIT-6 Headache Impact Test

HIT-6 uses six questions to measure adult headache impact over the previous 4 weeks. It does not identify the headache cause or count medicine days.

Read the test guide

Brain MRI when symptoms or examination findings warrant it

Brain MRI may help when symptoms, examination, age, injury, cancer, reduced immunity, pregnancy, or a major change raises a specific concern.

Read the test guide

Medication Review

Medication Review checks every prescription, over-the-counter medicine, supplement, caffeine product, nicotine product, cannabis product, and alcohol use. Do not stop a prescription without a safe plan.

Read the test guide

Before the appointment

Bring your diary, medicine list and earlier reports

Bring a diary showing the date and when the headache and trouble thinking start and end. Add pain, nausea, light or sound sensitivity, vision or speech changes, numbness, dizziness, sleep, meals, and what you could not do.

Start a diary now and bring whatever you have. Do not wait to complete it when a warning sign is present.

Bring every prescription, over-the-counter medicine, supplement, caffeine product, nicotine product, cannabis product, and alcohol estimate. Record the exact days each short-term headache medicine was used.

Bring earlier headache, eye, brain-scan, emergency, blood-pressure, blood, thyroid, iron, vitamin B12, sleep, or heart results. Bring complete reports. A cropped result isn't enough.

Write three things that your trouble thinking or headaches stopped you doing, such as driving, reading, cooking, working, studying, caring for someone, or taking medicines safely.

If headaches may be linked to periods, record headache days, medicine days, and period days for at least 2 menstrual cycles.

For a child or teenager, bring school attendance, missed activities, vomiting, sleep, behavior changes, medicines, and notes from a parent, carer, or teacher.

Write down any new or changed symptom, the date it began, whether it happens without a headache, and whether it fully goes away.

Bring the diary even if it is incomplete

For each day, record when headache and trouble thinking begin and end, other symptoms, medicine names and times, sleep, meals, periods if relevant, and the main activity affected.

How the doctor assesses this

Symptoms that may link the thinking problems to migraine

  • Trouble thinking begins before, during, or after the person's usual migraine symptoms and improves as those symptoms pass.
  • On the same days, you may also have headache, nausea, sensitivity to light or sound, or your usual short-lived changes in vision, speech, or feeling.
  • Trouble thinking changed at the same time as headache days or migraine medicine use changed.

Signs that another condition or medicine needs checking

  • The trouble thinking does not change before, during, or after headaches and does not occur with nausea, light or sound sensitivity, or the person's usual migraine symptoms.
  • Trouble thinking stays the same every day while the headaches improve, stop, or remain unchanged.
  • Trouble thinking began after starting or changing a medicine and follows the time the person takes it.
  • Another condition may explain the timing more directly. Examples include loud snoring or breathing pauses during sleep, low blood pressure, low glucose, anemia, low iron, vitamin B12 deficiency, thyroid disease, depression, anxiety, or infection.
  • New weakness, numbness, speech or vision trouble, confusion, seizure, fever, or head injury needs urgent assessment. So does a headache that becomes severe within one minute. Do not assume these symptoms are migraine.

What to understand before choosing care

How the doctor checks for migraine

  • Migraine can include trouble finding words, concentrating, reading, remembering steps, or thinking quickly. These symptoms can happen before, during, or after the headache.
  • Trouble thinking on days without a headache still deserves review. Research doesn't show that migraine causes every ongoing memory or attention problem in a person with migraine.
  • Diaries help the doctor compare headache days, trouble thinking, other symptoms, medicine days, sleep, meals, periods if relevant, and daily function.
  • A stable migraine history with a normal neurological examination and no warning signs usually does not need routine brain imaging. New or changed symptoms may change that decision.
  • The aim is to reduce migraine days and disability safely, while checking sleep, medicines, blood pressure, anemia, thyroid disease, and other causes when the history supports them.

What the research found

What studies found about thinking and memory

A 2024 review found that people with migraine often report trouble thinking, but results from formal thinking tests vary. Migraine, pain, medicines, sleep, anxiety, depression, and blood-vessel health may all contribute.

A 2024 meta-analysis combined 58 studies with 5,452 people with migraine and 16,647 comparison participants. Average differences were small to moderate, study results varied greatly, and stronger differences came mainly from clinic samples. The result cannot predict one person's memory or attention.

A 2026 systematic review found no clear overall loss of short-term memory in adults with migraine. It found a difference in working memory, which means holding and using information for a task. This does not create a diagnostic test for migraine brain fog.

A 2026 study tested 32 people with episodic migraine, 32 with chronic migraine, and 30 people without migraine. Thinking scores worsened during an untreated migraine headache, but the study was small and cannot show how every person functions between headaches.

A 2026 MIND Cohort preprint included 139 people and 3,014 person-days. The authors reported an association between migraine-headache days, higher brain-fog ratings, and small changes on some phone tasks. This result is preliminary because the paper has not completed peer review and 84.9% of participants were female. The study can't tell what causes one person's lasting trouble thinking.

Children, pregnancy, hormones and later life

Migraine occurs in children and adults. A child may stop playing, seek a dark room, vomit, miss school, or struggle to describe light and sound sensitivity. Use a children's assessment. Adult score ranges don't apply.

Adult women have migraine more often than adult men. Periods, pregnancy, postpartum changes, and menopause can change headache timing, but a headache near a period is not proof that hormones are the only cause.

When menstrual migraine is possible, NICE recommends a diary for at least 2 menstrual cycles. Women and girls with migraine with aura also need a personal contraceptive safety review.

Pregnancy and the weeks after birth change both medicine safety and which causes need ruling out. A new or different severe headache needs direct pregnancy care.

A first new headache after age 50 is a warning sign. New or worsening thinking problems in an older adult need medical review before anyone blames them on a past migraine diagnosis.

If the answer is no

If your doctor will not order brain imaging for migraine

A scan is often not needed when the symptoms match migraine, the nerve and brain exam is normal, and there are no warning signs. The American Headache Society says your history, headache timing, symptoms, and exam guide the decision. A normal scan cannot prove or rule out migraine-related brain fog.

What changes the answer

  • Bring a record of headaches and thinking changes. Record headache days, aura, nausea, light or sound sensitivity, medicines and when word-finding or concentration problems occur relative to each attack.
  • Ask what the nerve and brain exam showed. A normal exam and headaches that have stayed the same support a different scan decision from new weakness or a major change in the pain.
  • Name anything new about the headaches. Tell the doctor about a first or worst headache, a lasting aura, worse pain, pain always on one side, or symptoms after an injury.
  • Ask for a migraine plan even without a scan. Ask about diagnosis, treatment during an attack, prevention, medicine overuse, and when a change in your headaches needs another review.
American Headache Society: overview of migraine diagnosis

United States, United Kingdom, and Australia

Getting migraine care

US United States

Bring the diary and ask what needs checking first. Ask the clinician to confirm the headache diagnosis, count headache and medicine days, review warning signs and medicines, and decide the next useful step.

  • The American Headache Society says medicines that target calcitonin gene-related peptide can be among the first options for prevention. The choice still depends on health history, pregnancy, side effects, cost, coverage, and preference.
  • VA and DoD patient tools include a 7-day diary and a 3-month diary. ACOG has separate guidance for headaches during pregnancy and after birth.
Read American Headache Society diagnosis and imaging guidance, VA and DoD headache guideline, and ACOG pregnancy guidance
UK United Kingdom

Ask the GP to separate migraine from medicine effects and other causes. Ask whether the timing meets migraine criteria, whether frequent headache medicine may be worsening headaches, and whether warning signs or ongoing fog need another assessment.

  • NICE says that if a diary is used to help diagnose a primary headache, it should cover at least 8 weeks. When menstrual migraine is suspected, NICE recommends recording at least 2 menstrual cycles.
  • Medication-overuse headache may be considered when headaches worsen after at least 3 months of frequent medicine use. NICE uses 10 or more days a month for triptans, opioids, ergots, or combination pain medicines, and 15 or more days for paracetamol, aspirin, or an NSAID.
  • NICE says topiramate must not be used for migraine prevention during pregnancy. Access rules for calcitonin gene-related peptide medicines also differ from US guidance.
Read NICE Headaches in over 12s: diagnosis and management, CG150
AU Australia

Ask whether migraine, medicine use, or another condition best explains the symptoms. Ask what the diary shows and whether you need a medicine review, another check, or specialist care.

  • Headache Australia provides a 2026 headache diary and explains how medicine days, symptoms, and daily activities can help a doctor assess recurring headaches.
  • Its guidance gives two points to discuss when medicine use and worsening headache may be connected. These are 10 days a month for triptans and 15 days a month for simple pain medicines.
  • A GP can review the diagnosis, medicines, warning signs, sleep, blood pressure, and other causes, then refer to a neurologist or headache clinic when needed.
Read Headache Australia headache diary and personal management guidance

Safety

Show how it affects daily life

  • For recurring, non-urgent symptoms, record headache days, times of trouble thinking, other symptoms, short-term medicine days, sleep, meals, periods if relevant, and the main activity affected. Bring what you have even if it is incomplete.
  • Keep sleep and wake times, meals, and water intake as steady as is realistic. Do not skip food, lose sleep, or stop medicine on purpose to try to cause symptoms.
  • When thinking or vision is impaired, avoid driving, heights, machinery, financial decisions, or taking extra medicine without checking the label and plan.
  • Use lower light, lower sound, a quieter room, and shorter tasks when those changes make symptoms easier to manage. Check whether they help instead of assuming they will.
  • Do not remove many foods or start several supplements at once. Change one safe routine at a time so you and the clinician can tell what happened.
  • Save the diagnosis, aura status, headache days per month, short-term medicine days per month, medicines tried, useful results, warning-sign plan, and follow-up date in My Fog.

Source checked

Sources behind this handout.

  1. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. CG150. Updated June 3, 2025; reviewed December 1, 2025.

    Source

  2. National Institute for Health and Care Excellence. Headache diagnosis and headache diary: information for the public. CG150.

    Source

  3. American Headache Society. Overview of Migraine Diagnosis.

    Source

  4. American Headache Society. Updated Guidelines for Neuroimaging in Migraine.

    Source

  5. American College of Radiology. ACR Appropriateness Criteria: Headache.

    Source

  6. American College of Obstetricians and Gynecologists. Headaches in Pregnancy and Postpartum. Clinical Practice Guideline No. 3. 2022; reaffirmed 2024.

    Source

  7. National Institute of Neurological Disorders and Stroke. Migraine.

    Source

  8. US Department of Veterans Affairs and Department of Defense. Clinical Practice Guideline for Management of Headache. 2023; patient tools updated 2024.

    Source

  9. Headache Australia. Headache and Migraine Diaries, including the 2026 diary.

    Source

  10. Headache Australia. Personal Management.

    Source

  11. Fernandes C et al. Migraine and cognitive dysfunction: a narrative review. J Headache Pain. 2024;25:221. PMID 39701926.

    Source

  12. Pizer JH et al. Neuropsychological Function in Migraine Headaches: An Expanded Multidomain Meta-Analysis. Neurology. 2024;102:e208109. PMID 38252898.

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  13. McKay K, Kelly K. Investigating the impact of migraine on short-term and working memory: a systematic review and meta-analysis. J Neurol. 2026. PMID 41843171.

    Source

  14. Kizilkilic EK et al. Interictal and Ictal Cognitive Performance in Episodic and Chronic Migraine. Eur J Neurol. 2026;33:e70584. PMID 41889112.

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  15. Khorsand B et al. Digital Assessment of Objective and Patient-Reported Cognition Across Migraine Phases: Results from the MIND Cohort. medRxiv preprint. 2026. PMID 42064948.

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  16. Charles AC et al. Calcitonin gene-related peptide-targeting therapies are a first-line option for the prevention of migraine: An American Headache Society position statement update. Headache. 2024;64:333-341. PMID 38466028.

    Source

  17. Oskoui M et al. Practice guideline update summary: Pharmacologic treatment for pediatric migraine prevention. Neurology. 2019;93:500-509. PMID 31413170.

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