Recently I've started working one a new site and this will be my first site that uses a database that wasn't preconfigured (wordpress / drupal).

I'm just curious what everyone uses to design their database structure, layout the types/primary keys etc...

I've been doing it in Microsoft Excel. I gave Microsoft Access a try but found it tedious when everything is changing around so much. When it comes to laying out the relationships I may have to try it again but until then Excel seems to be working. Eventually when done the design I will be using MySQL Database.

So, do you use Excel, Access, Pencil/Paper, handbomb trial/error, etc...?