Types of Migraine

Have you ever met someone who also has migraine, but when you start to compare notes on your experiences it feels like you have completely different diseases? It has happened to me more times than I can count. Migraine is an extremely complex, diverse disease. The sheer number of symptoms that patients can experience is one of the main hurdles that doctors have to overcome when diagnosing and treating migraine. This page should serve as a reference tool to help you identify which type of migraine you are experiencing, and enable you and your doctor to develop a more effective treatment strategy. It is important to note that you can experience more than one type of migraine and that your symptoms can evolve overtime.

Quick reference list:

1. Migraine without aura
2. Chronic and episodic migraine
3. Menstrual migraine
4. Migraine with aura
   • Migraine with brainstem aura
   • Hemiplegic migraine
     • Familial hemiplegic migraine
   • Retinal migraine
5. Medication overuse headache
6. Satus/refractory/intractable migraine

All the information presented here is sourced from the International Classification of Headache Disorders (ICHD-3).

1. Migraine without aura – Defined as a recurrent headache disorder with attacks lasting 4-72 hours. Patients usually present with moderate to severe, pulsating unilateral head pain. Exercise or other physical activities tend to aggravate the pain and patients commonly report nausea, photophobia (sensitivity to light) and/or phonophobia (sensitivity to sound).
2. Chronic and episodic migraine – Chronic migraine is defined as attacks that occur 15 days or more per-month for more than three months, and migraine symptoms must be present for 8 of the 15 head pain days. Note that medication overuse headache can exist concurrently with a diagnosis of chronic migraine. Episodic migraine is classified as attacks that occur for 14 days per-month or less.
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3. Menstrual migraine – Menstrual migraine attacks are associated with the majority of one’s menstrual cycles and usually lack aura symptoms (see #4). Unfortunately, menstrual migraine episodes tend to be longer and accompanied by more severe nausea. If you menstruate, be sure to track your cycle along with your migraine episodes. Click here for a planner that will help you track your pain levels and your cycle.
4. Migraine with aura – This major class of migraine is described as recurrent attacks with transient neurological symptoms that precede head pain. These neurological indicators most commonly include fully reversible visual, sensory, or lingual symptoms. Patients who have migraine with aura can also have attacks without aura. The most prevalent aura symptom is the appearance of zig-zag lines at the center of the visual field. The second most common aura is a sensation of pins and needles on one side of the body, face or tongue. *Note that a patient can also experience aura symptoms without head pain, known as ‘typical aura without headache’. It is true, some migraineurs never experience pain!
   • Migraine with brainstem aura – This sub-class of migraine with aura is described as migraine with aura symptoms “clearly” originating from the brainstem in the absence of motor weakness. The aura symptoms have to include at least two of the following: fully reversible dysarthria (difficulty pronouncing words), vertigo (dizziness), tinnitus (ringing in the ears), hypacusis (difficulty hearing), double vision, ataxia (loss of control of bodily movements), or a decreased level of consciousness; and there must be no motor or retinal symptoms. It is common for patients with brainstem aura to also present with typical aura.
   • Hemiplegic migraine – This type of migraine with aura is one that includes motor symptoms. The symptoms are fully reversible motor weakness, in addition to fully reversible visual, sensory and/or speech/language symptoms.
     • Familial hemiplegic migraine (FMH) – A subgroup of hemiplegic migraine, FMH is characterized as hemiplegic migraine with one first- or second-degree relative also having migraine aura with motor weakness. New genetic evidence has demonstrated that this type of migraine is attributable to one of three potential genetic mutations. You can have a genetic test done to determine what type of FMH you have (1-3). FMH commonly presents with similar symptoms to migraine with brainstem aura and can be mistakenly diagnosed as epilepsy.
   • Retinal migraine – Retinal migraine is also a sub-type of migraine with aura and is defined as repeated attacks of ‘monocular’ (single eye) visual disturbances. These visual symptoms can include scintillations (flashes / sparkles of light), partial loss of vision, or complete blindness, and are followed by migraine head pain.
5. Medication overuse headache – An increase in migraine attack frequency with repeated use of abortive medications (i.e. triptans). Patients with migraine without aura are more prone to develop medication overuse headache. If you experience an increase in attack frequency with the increased use of your medications, talk to your doctor immediately. Once the medication overuse headache begins, it can be very difficult to break the cycle.
6. Status migrainous – Also referred to as intractable / refractory migraine, this migraine is defined as a debilitating attack that lasts for more than 72 hours. Status migraine can occur in patients with migraine with or without aura.

Did you know all the different types of migraine? The truth is that there are even more than what I detailed here, but what I left out are minor subdivisions of the ones listed. I hope that this list can serve as a reference for you and can facilitate open, detailed conversations with your doctor. The more accurate your diagnosis, the more tailored and effective your treatment plan can become!

If you want to check out the most recent version of the International Classification of Headache Disorders document for yourself, you can find it here: ICHD-3 beta. The migraine classification list starts on page 18.

Have a question? Leave a comment below, email me at lifewithmigraine@gmail.com, or contact me on Instagram @lifewithmigraine.