What Is Complicated Migraine?

Migraine headaches are common, affecting around 10% of the population worldwide. These throbbing headaches are typically located on one side of the head and may be accompanied by an aura. A migraine aura precedes a headache and is associated with visual, sensory, and/or speech disturbances that last up to one hour.

The term “complicated migraine” is outdated and no longer used within the medical community. Although there was no clear consensus on the term's exact definition, "complicated migraine" was historically used by healthcare providers to describe migraine with aura and/or migraines associated with prolonged or atypical aura symptoms.

This article will review the symptoms, diagnosis, and treatment of two migraine subtypes associated with prolonged or atypical aura symptoms. These rare subtypes were perhaps considered "complicated" in the past.

Symptoms

The aura symptoms of a typical migraine with aura are fully reversible, occur on only one side of the body or visual field, and usually last no more than one hour.

These symptoms include:

• Visual symptoms: Seeing bright spots or zigzag lights
• Sensory symptoms: Numbness or tingling that develops on one side of the face or spreads down one arm
• Speech symptoms: Trouble finding words or slurring your words
  

Hemiplegic Migraine

Hemiplegic migraine is a rare, quite dramatic subtype of migraine with aura.

It may have been considered "complicated" because its aura consists of weakness on one side of the body. This weakness usually lasts less than 72 hours but may persist for weeks in some patients.

Besides weakness, people with hemiplegic migraine also tend to experience typical aura symptoms (e.g., visual, sensory, and/or speech disturbances).

Migraine With Brain Stem Aura

Migraine with brain stem aura (MBA)—previously known as basilar-type migraine—may have been considered "complicated" because its aura symptoms are unusual and can last for several hours, even days, in some patients.

Symptoms include:

• Double vision
• Vertigo, or a spinning sensation
• Tinnitus (ringing in the ears)
• Oversensitivity to sound
• Slurred speech
• Weakness and numbness on both sides of the body
• Fainting or loss of consciousness
  

Causes

A typical migraine with aura is caused by a phenomenon called cortical spreading depression (CSD).

Hemiplegic Migraine

Hemiplegic migraine also results from CSD occurring in the cortex. In addition, various genetic mutations (changes in DNA sequence) have been linked to hemiplegic migraine.

Depending on how these genetic mutations are obtained, hemiplegic migraine is further divided into two different types, as follows:

• Familial hemiplegic migraine is inherited, which means that any genetic mutations are passed down in family members.
• Sporadic hemiplegic migraine is less common and is not inherited, which means that the genetic mutations occur randomly.

Migraine With Brain Stem Aura

Migraine with brain stem aura involves at least two symptoms that originate within the brain stem (e.g., vertigo, tinnitus, and double vision).

Interestingly, despite its previous name, there is no evidence that the basilar artery (located at the base of the skull) is involved in this unique type of migraine.

Diagnosis

To diagnose any type of migraine, a neurologist (a doctor who specializes in disorders of the nervous system) will take a detailed medical and family history and perform a neurological exam.

If the neurological exam is abnormal, an electroencephalogram (EEG) (electrodes detect brain activity) and imaging tests, notably magnetic resonance imaging (MRI) of the brain and its blood vessels, will also usually be performed.

The purpose of these diagnostic tests is to rule out mimicking conditions or conditions considered a "complication" of a migraine.

Such conditions include:

• Seizure (uncontrolled electrical activity in the brain) or migraine-triggered seizure
• Stroke (blockage of blood flow or bleeding in the brain) or migrainous infarction (a stroke that starts during a migraine attack)

Treatment

Mild to moderate migraine with auras are often relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil (ibuprofen) or Aleve (naproxen sodium), whereas more severe migraines with auras often require a triptan, like Imitrex (sumatriptan), or a combination NSAID/triptan like Treximet (sumatriptan and naproxen sodium).

For people who cannot take or tolerate a triptan, a calcitonin gene-related peptide (CGRP) blocker, like Zavzpret (zavegepant), may be tried.

People with hemiplegic migraine and migraine with brainstem aura are usually treated with an NSAID. Triptans are generally avoided.

Coping

Coping with any migraine disorder can be daunting and challenging. The upside is that simple strategies can help you improve your quality of life and navigate your diagnosis well.

These strategies may include:

• Keeping a journal: Record your daily or weekly thoughts, worries, and goals. This can help you sort out the steps you need to take to best manage your migraines and help you feel more in control.
• Finding a headache specialist: Ask your primary care physician or neurologist for a referral, or use a resource like the American Migraine Foundation.
• Asking for support: Reach out to loved ones, support networks online, or a therapist for emotional guidance and comfort.
• Adopting a healthy lifestyle: Eat well, exercise daily, and stick to a regular sleep schedule. These habits may help prevent migraines and make you feel better overall.

Summary

Although an outdated term, "complicated migraine" historically referred to migraine with aura and/or migraines associated with prolonged or atypical aura symptoms. The latter is seen in hemiplegic migraine and migraine with brain stem aura.

A Word From Verywell

If you or a loved one has been diagnosed with hemiplegic migraine or migraine with brain stem aura, be sure to see a headache specialist who has experience managing these rare migraine subtypes. Together, you and your healthcare provider can build a treatment plan that is safe, effective, and fits well within your daily routine.