21 Jun All About Migraines, Part One: A Myriad of Migraines
Migraines: everyone’s heard of them; many of us suffer from them—or will suffer a migraine at some point in our lives.
So what are migraines, exactly? How do they differ from “regular” headaches? How are they diagnosed, treated, avoided?
In Part One of our All About Migraines mini-series, we’re looking at all the different types of migraines. Part Two will examine causes and symptoms, and Part Three will address migraine treatment options.
First, what is a migraine?
Migraine is a neurological condition, frequently characterized by intense, debilitating headaches. Additional symptoms may include:
- difficulty speaking
- numbness or tingling
- sensitivity to light and sound
Migraines can begin in childhood or may not occur until early adulthood. Women are more likely than men to have migraines. Family history is one of the most common risk factors for having migraines.
Now, onto the many, many types of migraines.
Two of the most common types are migraine without aura (previously known as “common migraines”) and migraine with aura (previously known as “classic migraines”). Some people have both types.
Migraine without aura
Most people with migraine don’t experience an aura.
- Headache attack usually lasting 4 to 72 hours if it’s not treated or if treatment doesn’t work.
- Headache has at least two of these traits:
- it occurs only on one side of the head (unilateral)
- pain is pulsating or throbbing
- pain level is moderate or severe
- pain gets worse when you move, like when walking or climbing stairs
- Headache has at least one of these traits:
- it makes you sensitive to light (photophobia)
- it makes you sensitive to sound (phonophobia)
- you experience nausea with or without vomiting or diarrhea
- Headache isn’t caused by another health problem or diagnosis.
Migraine with aura
You must have at least two attacks that have these characteristics:
- An aura that goes away, is completely reversible, and includes at least one of these symptoms:
- visual problems (the most common aura symptom)
- sensory problems of the body, face, or tongue, such as numbness, tingling, or dizziness
- speech or language problems
- problems moving or weakness, which may last up to 72 hours
- brainstem symptoms, which includes:
- difficulty talking or dysarthria (unclear speech)
- vertigo (a spinning feeling)
- tinnitus or ringing in the ears
- hypacusis (problems hearing)
- diplopia (double vision)
- ataxia or an inability to control body movements
- decreased consciousness
- eye problems in only one eye, including flashes of light, blind spots, or temporary blindness (when these symptoms occur they’re called retinal migraines)
- An aura that has at least two of these traits:
- at least one symptom spread gradually over five or more minutes
- each symptom of the aura lasts between five minutes and one hour (if you have three symptoms, they may last up to three hours)
- at least one symptom of the aura is only on one side of the head, including vision, speech, or language problems
- aura occurs with the headache or one hour before the headache begins
- Headache isn’t caused from another health problem and transient ischemic attack has been excluded as a cause.
An aura usually occurs before the headache pain begins, but it can continue once the headache starts. Alternatively, an aura may start at the same time as the headache does.
Chronic migraine used to be called combination or mixed headache because it can have features of migraine and tension headaches. It’s also sometimes called severe migraine and can be caused by medication overuse.
People who have chronic migraines have a severe tension or migraine headache more than 15 days a month for 3 or more months. More than eight of those headaches are migraines with or without aura.
Compared to people who have acute migraines, people with chronic migraines are more likely to have:
- severe headaches
- more disability at home and away from home
- another type of chronic pain, like arthritis
- other serious health problems (comorbidities), such as high blood pressure
- previous head or neck injuries
People who have episodic migraines have headaches up to 14 days a month. Thus, people with episodic migraines have fewer headaches a month than people with chronic ones.
Vestibular migraine is also known as migraine-associated vertigo. About 40 percent of people who have migraines have some vestibular symptoms. These symptoms affect balance, cause dizziness, or both. People of any age, including children, may have vestibular migraines.
Neurologists typically treat people who have difficulty managing their migraines, including vestibular migraines. Medications for this type of migraine are similar to ones used for other types of migraine. Vestibular migraines are also sensitive to foods that trigger migraines. So you may be able to prevent or ease vertigo and the other symptoms by making changes to your diet.
Your doctor may also suggest you see a vestibular rehabilitation therapist. They can teach you exercises to help you stay balanced when your symptoms are at their worst. Because these migraines can be so debilitating, you and your doctor may talk about taking preventive medications.
Optical migraine is also known as eye migraine, ocular migraine, ophthalmic migraine, monocular migraine, and retinal migraine. This is a rarer type of migraine with aura, but unlike other visual auras, it affects only one eye.
The International Headache Society defines retinal migraines as attacks of fully reversible and temporary vision problems in only one eye. The symptoms may include:
- flashes of light, called scintillations
- a blind spot or partial loss of vision, called scotomata
- loss of vision in one eye
These vision problems usually occur within an hour of the headache. Sometimes optical migraines are painless. Most people who have an optical migraine have had another type of migraine before.
Exercise may bring on the attack. These headaches aren’t caused from an eye problem, such as glaucoma.
Complex migraine isn’t a type of headache. Instead, complex or complicated migraine is a general way to describe migraines, though it’s not a very clinically accurate way to describe them. Some people use “complex migraine” to mean migraines with auras that have symptoms that are similar to symptoms of a stroke. These symptoms include:
- trouble speaking
- loss of vision
Seeing a board-certified headache specialist will help ensure that you get a precise, accurate diagnosis of your headaches.
Menstrual-related migraines affect up to 60 percent of women who experience any type of migraine. They can occur with or without an aura. They can also occur before, during, or after menstruation and during ovulation.
Research has shown that menstrual migraines tend to be more intense, last longer, and have more significant nausea than migraines not associated with the menstrual cycle.
In addition to standard treatments for migraines, women with menstrual-related migraines may also benefit from medications that affect serotonin levels as well as hormonal treatments.
Acephalgic migraine or migraine without headache
Acephalgic migraine is also known as migraine without headache, aura without headache, silent migraine, and visual migraine without headache. Acephalgic migraines occur when a person has an aura, but doesn’t get a headache. This type of migraine isn’t uncommon in people who start having migraines after age 40.
Visual aura symptoms are most common. With this type of migraine, the aura may gradually occur with symptoms spreading over several minutes and move from one symptom to another. After visual symptoms, people may have numbness, speech problems, and then feel weak and unable to move a part of their body normally.
Also known as menstrual migraines and exogenous estrogen withdrawal headaches, hormonal migraines are linked with the female hormones, commonly estrogen. They include migraines during:
- your period
- the first few days after you start or stop taking medications that have estrogen in them, such as birth control pills or hormone therapy
If you’re using hormone therapy and have an increase in headaches, your doctor may talk with you about:
- adjusting your dose
- changing the type of hormones
- stopping hormone therapy
Stress migraine isn’t a type of migraine recognized by the International Headache Society. However, stress can be a migraine trigger.
There are stress headaches. These are also called tension-type headaches or ordinary headaches. If you think stress may be triggering your migraines, consider yoga for relief.
Cluster migraine isn’t a migraine type defined by the International Headache Society. However, there are cluster headaches. These headaches cause extreme pain around and behind the eye, often with:
- tearing on one side
- nasal congestion
They can be brought on by alcohol or excessive smoking. You may have cluster headaches as well as migraines.
Vascular migraine isn’t a migraine type defined by The International Headache Society. Vascular headache is a term that some people may use to describe a throbbing headache and pulsation caused by a migraine.
Migraines in children
Children can have many of the same types of migraines as adults. Children and teens, like adults, can also experience depression and anxiety disorders along with their migraines.
Until they’re older teens, children may be more likely to have symptoms on both sides of the head. It’s rare for children to have headache pain in the back of the head. Their migraines tend to last 2 to 72 hours.
A few migraine variants are more common in children. These include abdominal migraine, benign paroxysmal vertigo, and cyclic vomiting.
Children with abdominal migraine may have a stomachache instead of a headache. The pain can be moderate or severe. Usually pain is in the middle of the stomach, around the belly button. However, the pain may not be in this specific area. The belly may just feel “sore.”
Your child may also have a headache. Other symptoms can include:
- lack of appetite
- nausea with or without vomiting
- sensitivity to light or sound
Children who have abdominal migraine are likely to develop more typical migraine symptoms as adults.
Benign paroxysmal vertigo
Benign paroxysmal vertigo can occur in toddlers or young children. It occurs when your child suddenly becomes unsteady and refuses to walk, or walks with their feet spread wide, so they’re wobbly. They may vomit. They may also experience a headache.
Another symptom is rapid eye movements (nystagmus). The attack lasts from a few minutes to hours. Sleep often ends the symptoms.
Cyclic vomiting often occurs in school-age kids. Forceful vomiting may occur four to five times an hour for at least one hour. Your child may also have:
- stomach pain
- sensitivity to light or sound
The symptoms may last for 1 hour or up to 10 days.
In between vomiting, your child may act and feel completely normal. Attacks can occur a week or more apart. The symptoms may develop a pattern of occurrence that become recognizable and predictable.
The symptoms of cyclic vomiting may be more noticeable than other migraine symptoms that children and teens experience.
Migraines and pregnancy
For many women, their migraines improve during pregnancy. However, they may become worse following delivery due to sudden hormonal shifts. Headaches during pregnancy need special attention to make sure that the cause of the headache is understood.
Research is ongoing, but a recent small study showed that women with migraine during pregnancy experienced a higher rate of having:
- preterm or early delivery
- a baby born with low birth weight
Certain migraine medications may not be considered safe during pregnancy. This can include aspirin. If you have migraines during pregnancy, work with your doctor to find ways to treat your migraine that won’t harm your developing baby.
Migraine vs tension headache
Migraine and tension headache, the most common type of headache, share some similar symptoms. However, migraine is also associated with many symptoms not shared by tension headaches. Migraines and tension headaches also respond differently to the same treatments.
Both tension headaches and migraines can have:
- mild to moderate pain
- a steady ache
- pain on both sides of the head
Only migraines can have these symptoms:
- moderate to severe pain
- pounding or throbbing
- an inability to do your usual activities
- pain on one side of the head
- nausea with or without vomiting
- an aura
- sensitivity to light, sound, or both
Talk to your doctor
This always goes without saying: before you self-diagnose or, really, do anything about your migraine symptoms, it’s best to contact your doctor. You can also reach out to one of the PHMP Health Coaches by phone (1-855-498-4643) or email!
This article was brought to you by the Proactive Health Management Plan in partnership with Healthline.