Article taken from www.migraineagain.com/migraine-types/
Understanding Each Type of Migraine
According to the International Classification of Headache Disorders (ICHD-3), the two most common migraine types are migraine with aura (common migraine symptoms) and migraine without aura. Essentially the only difference is that one includes migraine attacks that have aura and the other doesn’t.
The other common characterization of these migraine types is as episodic or chronic, and that is distinguished by the frequency of headache days.
Then there are also subtypes that are distinguished by specific types of symptoms, like migraine aura without headache, migraine with brainstem aura (formerly called basilar-type migraine), hemiplegic migraine, and retinal migraine.
Chronic migraine attacks are characterized by 15 or more headache days per month for more than three months. Headache may be migraine-like or tension-type-like, but it has the characteristics of migraine on at least eight days per month. Chronic migraine is often disabling.
Migraine attacks can be with or without aura, and they usually require preventive medications and behaviors to keep them under control. After stopping medication, about half of chronic migraine patients revert to episodic migraine and half do not.
Preventive habits are highly advised to keep the condition from progressing from episodic to chronic. Learn about the factors that may increase your risk of developing chronic migraine.
Migraine With Aura
What Is an Aura?
Aura typically refers to symptoms that occur before the headache of a migraine attack, but they also may occur during the headache phase. The aura phase affects approximately one-third of people with migraine.
Aura symptoms typically last from several minutes to an hour and then resolve completely. Occasionally they may last for more than an hour, and rarely may even last for days.
There are multiple possible symptoms of aura, including visual, sensory, language, and motor symptoms. Common aura symptoms include:
- Scintillating scotoma: This refers to a “hole” in the vision that spreads with a leading edge that is flickering. Sometimes the leading edge is a series of intersecting jagged lines that are either in black and white or in color. This is referred to as a “fortification spectra” because the intersecting jagged lines may resemble those of a fortress.
- Flashing lights
- Tunnel vision
- Holes in the vision without flickering or shimmering where objects appear larger or smaller than they actually are.
- Tingling sensation: A sensory migraine aura typically causes a tingling or “pins and needles” sensation, commonly on one side of the body. It may also have an “electrical” quality. The most common locations for these sensory symptoms are on the face and arm, although they may occasionally involve the legs and trunk.
- Numbness: Numbness or the absence of sensation may occur, typically on one side of the body.
- Difficulty with speech: This is typically described as difficulty finding words or increased effort required to produce speech. Occasionally, there may be word substitution, meaning the use of an inappropriate word in place of the word that is actually intended.
- Clumsiness or weakness: Motor symptoms, including clumsiness or weakness in part of the body, most commonly the arm and hand. This may manifest as difficulty performing fine motor tasks, but in severe cases may result in significant weakness or even paralysis (known as hemiplegic migraine).
In some cases, the migraine aura may progress from visual symptoms to sensory symptoms to language and motor symptoms in some sequence. In others, however, there may be no clear progression, and aura symptoms may occur simultaneously.
The occurrence of the migraine aura, as with other migraine symptoms, is highly variable from person to person as well as from attack to attack within a given individual.
4 Subtypes of Migraine With Aura
1. Migraine Without Headache
While aura is typically followed by or accompanied by headache, this is not always the case. Individuals may experience migraine aura with no headache, also known as acephalgic migraine or a silent migraine. This is particularly common in older individuals.
Fever, dizziness, and/or unexplained pain in a particular part of the body also could be possible types of headache-free migraine. It’s different from the complications known as abdominal migraine and cyclical vomiting syndrome, which often affect children. Abdominal migraines, in particular, are more common in children.
2. Migraine With Brainstem Aura (Formerly Called Basilar-Type Migraine)
There is also a classification of a set of symptoms that are believed to originate in the base of the brain. This is referred to as “brainstem aura.” Mainly affecting children and adolescents, migraine with brainstem aura includes migraine with aura symptoms that originate from the brainstem, but without motor weakness. It occurs most often in teenage girls and may be associated with their menstrual cycles. This can result in:
- Dizziness and vertigo
- Ringing in the ears
- Back and forth movements of the eyes
- Significant incoordination that is not associated with weakness
- Throbbing pain that comes on suddenly and is felt on both sides at the back of the head
These symptoms are classified as brainstem aura because they are believed to be produced by dysfunction of the regions of the base of the brain called the brainstem.
3. Hemiplegic Migraine
Hemiplegic migraine is a rare but severe form of migraine that causes temporary paralysis — sometimes lasting several days — on one side of the body before or during a headache.
Symptoms of hemiplegic migraine — such as vertigo; a pricking or stabbing sensation; and problems seeing, speaking, or swallowing — may begin prior to the headache pain and usually stop shortly thereafter.
When hemiplegic migraine runs in families, the disorder is called familial hemiplegic migraine. Though rare, at least three distinct genetic forms of familial hemiplegic migraine have been identified. These genetic mutations make the brain more sensitive or excitable, most likely by increasing brain levels of a chemical called glutamate, which can trigger hemiplegic migraine. Read about one hemiplegic migraine patient’s journey here.
4. Retinal Migraine
Retinal migraine is a very rare type characterized by vision loss or disturbances in one eye. Retinal migraine attacks, like the more common visual auras, are usually associated with head pain. Optical migraine, sometimes called ocular migraine, is different because it affects vision in both eyes.
Migraine Without Aura
Migraine without aura, formerly called common migraine or migraine headache, is the most common type of migraine diagnosed. Around 60 percent to 70 percent of individuals with migraine do not have migraine symptoms (aura) associated with their attacks, so migraine without aura is their primary diagnosis.
Migraine is a genetically determined, neurological disease that is characterized by episodes or attacks that have different phases within them. The phases of migraine with aura include the premonitory or prodrome phase, the aura phase, the headache phase, and the postdrome phase.
Migraine without aura includes all of the symptoms and phases of a migraine attack, but without the visual, sensory, language, or motor symptoms that are classified as aura. An attack of migraine without aura includes three phases: the prodrome phase, the headache phase, and the postdrome phase.
Prodrome Phase
A warning phase, or prodrome phase, may occur hours or days before the headache associated with a migraine attack. Warning symptoms may continue into the headache phase.
Along with nausea, vomiting, and sensitivity to stimuli, other warning symptoms may include:
- Confusion (cognitive dysfunction)
- Fatigue
- Food cravings
- Mood changes
- Neck stiffness
- Pain
- Visual symptoms, such as blurred vision
- Yawning
These symptoms also may occur in migraine with aura.
Headache Phase and Postdrome Phase
The headache phase may be followed by a postdrome phase (hangover phase). Postdrome symptoms include cognitive impairment and feeling tired or “washed out.”
Length and Frequency
Migraine attacks typically last 4 to 72 hours. The attacks may repeat a few times a year or a few times a week. Migraine without aura is the type more prone to worsen with frequent use of symptomatic medication.
Can Someone Have Both Migraine Types, With and Without Aura?
It’s very common for those with migraine to have occasional aura and therefore qualify for the diagnosis of both migraine types — migraine with and without aura.
The occurrence of the migraine aura is highly variable from person to person as well as from attack to attack within a given individual. Some people have only two or three attacks of migraine aura during their lifetime, whereas others experience aura symptoms with a higher percentage of their attacks. A small number of patients have aura with 100 percent of their attacks.
No matter what type of migraine you have, getting an accurate diagnosis is important. With the right diagnosis, you and your healthcare provider can develop appropriate care plans forprevention and treatment of migraine.