Clinician handoff
Migraine
Designed for a 60-second scan in primary care. Use this to explain why this theory fits, what would weaken it, and which tests are most worth discussing.
Why this still fits
My brain fog often comes before, during, or after migraine episodes - but I also have between-episode fog that concerns me. I want to formally document the headache pattern and discuss whether preventive treatment would address both.
What would weaken it
- -No episodic pattern, no headache or sensory features, and no link to typical migraine triggers.
- -The fog is constant and unrelated to migraine flares, prodrome, or postdrome windows.
- -Sleep apnea, PCS, anxiety, or another cause explains the pattern more cleanly.
Key points to communicate
- •I want to know whether this is migraine-related cognition versus a different neurological or sleep problem.
- •Please separate migraine fog from PCS, cervical issues, and medication effects.
- •If migraine is central, I want to know what preventive or trigger strategies actually matter for the brain fog.
Bring this to the visit
- •A headache diary: frequency, duration, triggers, aura symptoms, and cognitive impact.
- •Current preventive and acute migraine medications with efficacy assessment.
- •A note about interictal symptoms: is fog present between migraines or only during attacks?
- •Menstrual cycle data if migraines have a hormonal pattern.
Useful screening structure
- -MIDAS (Migraine Disability Assessment) for disability documentation.
- -HIT-6 (Headache Impact Test) for severity quantification.
- -PHQ-9 since depression is common in chronic migraine and worsens cognitive symptoms.
Tests and measurements to discuss
Headache Diary Analysis (4+ weeks)
MIDAS (Migraine Disability Assessment)
What this helps clarify: MIDAS translates subjective migraine burden into a standardized disability grade.
Range context
Grade I-IV
How to use the result
Save the result with date and symptoms from the same week.
HIT-6 (Headache Impact Test)
What this helps clarify: HIT-6 captures the full impact of headache beyond just pain - including cognitive function, fatigue, and activity limitation.
Range context
36-78 score
How to use the result
Save the result with date and symptoms from the same week.
Neurology Referral Criteria
Questions to ask directly
- •Is my fog from the migraines themselves (interictal), from medication side effects, or a co-occurring cause?
- •Would a CGRP inhibitor help if topiramate or other preventives are causing cognitive side effects?
- •Should we investigate hormonal triggers if my migraines track with my menstrual cycle?
- •If I have chronic daily headache with continuous fog, should we consider medication overuse headache?
Functional impact snapshot
- -Track cognitive function during migraine, 24 hours after, and between migraines.
- -Rate whether preventive medications help or worsen cognitive function.
- -Note specific triggers: sleep changes, stress, foods, hormones, weather.
Escalate instead of self-managing if
- •Thunderclap headache (worst of life, seconds to peak) - needs urgent imaging.
- •New neurological deficits that persist after the migraine resolves.
- •Progressive increase in headache frequency or change in pattern in someone over 50.
Peer-reviewed references