In my case, I doodle with pen and paper. No computer for my creative process. Too much potential distraction housed in that plastic box. Blue pen and a blank piece of paper have always served me best in this regard.
Once I find some quiet time, and a quiet space, I get to work at being creative 
The first step, is identifying a need. Does the game need a sword, a piece of armor perhaps, or maybe a miscellaneous item.
Then I decide if the item is to be tied to a specific race, a specific skill/class, or open to all players.
And then the fun starts.
I’ll use an actual item I designed to walk you through my process.
I had noticed that the Goblins had not been getting very much attention from me lately. They needed some love, and a racial item was to be that love. Our Goblins are not the nicest beings on the continent of Zinnia. In fact, nasty might be a better word to describe them. So, the Goblins needed a “nasty” item.
I got up from my desk, walked around my home, and tried to imagine what would be nasty and foul to put on a body. Cap? No. Belt? Not really. Worn shirt perhaps? Almost, but not quite. Then I looked at my hands, and imagined putting ON a pair of hands. Boneless hands, like a pair of gloves. That image seemed foul enough to work with, and so I sat down at my desk again.
Every decent item needs a history, A background story players can read, and get a better sense/feel for the item in question.
I needed a decent Goblin name. After coming up with one, the background story of the item just fell into place magically. It wrote itself, and thus, The Fingers of Zxag Darkgut were born.
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