Types of Migraine

There are many different types of migraine — getting a proper diagnosis from a Headache Specialist is crucial in terms of making sure you get an appropriate treatment plan. 50% of people living with migraine go undiagnosed. Many people with migraine, especially those who are chronic, can have more than one type of migraine. This guide does not include other types of headache disorders such as Cluster, Hemicrania Continua and others.
Please note: This Guide is based on the latest International Classification of Headache Disorders 3 (ICHD-3) created by the International Headache Society.

1. Migraine without Aura

“Recurrent headache disorder manifesting in attacks lasting 4–72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.” (ICHD-3)

• Approximately 70–75% of people living with migraine experience migraine without aura (American Migraine Foundation)

2. Migraine with Aura

“Recurrent attacks, lasting minutes, of unilateral fully-reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated migraine symptoms.” (ICHD-3)

• Aura symptoms typically last 5–60 minutes but motor aura symptoms may last much longer.

• About 20–30% of people living with migraine experience migraine with aura.

• Aura symptoms may include:

⟐ Visual
⟐ Sensory
⟐ Speech & language
⟐ Motor
⟐ Retinal

There are many subtypes of Migraine with Aura. They include:

MIGRAINE AURA with HEADACHE

“Migraine with aura in which aura consists of visual and/or sensory and/or speech/language symptoms, but no motor weakness, and is characterized by gradual development, duration of each symptom no longer than one hour, a mix of positive and negative features and complete reversibility. The aura is accompanied or followed within 60 minutes by headache with or without migraine characteristics.” (ICHD-3)

MIGRAINE AURA without HEADACHE

“Migraine with typical aura in which aura is neither accompanied nor followed by headache of any sort.” (ICHD-3). While migraine is often thought to be defined by pain, the aura symptoms, even without headache, can be equally disabling for many people.

MIGRAINE with BRAINSTEM AURA

“Migraine with aura symptoms clearly originating from the brainstem, but no motor weakness.” (ICHD-3)

• Approximately 10% of people who have Migraine with Aura have MBA (Migraine Trust)

• Most people living with MBA also have Typical Migraine with Aura

• Brainstem Aura symptoms may include:

⟐ Dysarthria (muscles used to control speech are weakened or difficult to control resulting in slurred or slow speech)
⟐ Vertigo (but not dizziness)
⟐ Tinnitus
⟐ Hypacusis (partial hearing loss)
⟐ Diplopia (double vision, the perception of two images in a single object)
⟐ Ataxia (lack of muscle control and involuntary movements)
⟐ Decreased level of consciousness

HEMIPLEGIC MIGRAINE

“Migraine with Aura that includes motor weakness, and includes visual, sensory, and/or speech/language symptoms” (ICHD-3)

• This is an extremely rare form of migraine occurring in 0.01% of the total population. (ncbi.nlm.nih.gov)

• Motor symptoms may last 72 hours to weeks.

• Symptoms can often mimic stroke or seizures.

• This is one form of migraine in which diagnostic tests such as MRIs and scans may be used to rule out other causes of symptoms.

• There are two types of Hemiplegic Migraine: Familial Hemiplegic Migraine (genetic) and Sporadic Hemiplegic Migraine (new onset).

• Hemiplegic Migraine symptoms may include:

⟐ Numbness, weakness, or paralysis on one side of the body
⟐ Drooping on one side of the face
⟐ Pins and needles, tingling in the extremities
⟐ Nausea and vomiting
⟐ Photophobia
⟐ Phonophobia
⟐ Osmophobia
⟐ Visual Aura
⟐ Dysarthria (slurred speech or difficulty speaking)
⟐ Headache
⟐ Ataxia (lack of muscle control and involuntary movements)
⟐ Confusion and brain fog
⟐ Fever

RETINAL MIGRAINE

“Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with migraine headache.” (ICHD-3)

• Short-lasting bouts of diminished vision or blindness only in one eye. (Mayo Clinic)

• Aura symptoms must be fully reversible.

• Aura symptoms must spread from 5 minutes onwards, last 5-60 minutes, and may or may not be followed by headache.

• Retinal Migraine Symptoms may include:

⟐ Scintillations (flashing lights, zig-zag edges, shimmering spots spreading outwards)
⟐ Scotomas (blind spot in your vision)

VESTIBULAR MIGRAINE

This form of migraine has only been recognized in the past decade. It describes migraine that includes symptoms located in the vestibular system which includes the inner ear and balance system.

• A person must have at least five (5) episodes of vestibular symptoms lasting 5–72 hours and half of those episodes much have migraine features.

• Differential diagnosis by a neurologist is useful to determine which symptoms are Vestibular Migraine and which could be associated diseases like Ménières Disease or BPPV (Benign Paroxysmal Positional Vertigo).

• Headache is not always present with VM, in fact up to 50% of people with VM do not have accompanying headache.

• Migraine with Aura can often progress into Vestibular Migraine after menopause (Dr. Shin Beh).

• For more information on Vestibular Migraine see vestibular.org

• Vestibular Migraine Symptoms may include:

⟐ Dizziness
⟐ Vertigo
⟐ Lightheadedness
⟐ Depersonalization
⟐ Brain fog
⟐ Ataxia
⟐ Photophobia
⟐ Anxiety
⟐ Tinnitus

 3. Chronic Migraine

Chronic migraine patients have at least fifteen headache days per month — at least eight of which are migraines. It is important to limit the usage of acute medications to avoid Medication Overuse Headache. This necessitates working with your doctor to formulate an “Headache occurring on 15 or more days/month for more than three (3) months, which, on at least eight (8) days per month, has the features of migraine headache.” (ICHD-3)

• This classification of migraine is based on frequency rather than type. A person with chronic migraine can have any combination of the types of migraine listed above.

• Medication Overuse Headache should be ruled out. This is a type of secondary headache, not migraine, caused by the overuse of Acute Medications. It can only be determined through the discontinuation of these medications under the guidance of a physician.

• New Daily Persistent Headache presents in a similar way to chronic migraine, however it’s onset is marked by a specific date and it is a type of primary headache that is not classified as migraine.

4. Abdominal Migraine

“An idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms, nausea and vomiting, lasting 2–72 hours and with normality between episodes. Headache does not occur during these episodes.” (ICHD-3)

• Other sources of abdominal pain and gastrointestinal issues should be ruled out before the diagnosis is made.

• While it is rarer in adults, it is being increasingly recognized as a migraine disorder in adults.

• Abdominal Migraine Symptoms may include:

⟐ Moderate to severe abdominal pain
⟐ Loss of appetite
⟐ Nausea
⟐ Vomiting
⟐ Pallor