The Different Types of Migraines

A migraine is not just a really bad headache, as some people believe. Instead, it is an illness with a constellation of neurological symptoms that may include really bad headaches. There are several types of migraines, and many share some of the same symptoms, which typically include nausea, vomiting, dizziness, sensitivity to touch, smells, and light, and—in a few people—numbness and difficulties with speech.

Migraine without aura is often called "common migraine" or "episodic migraine." It is the most common type. Typical symptoms are a pulsating headache of moderate-to-severe intensity on one side of the head, aggravation by routine physical activity, nausea, and sensitivity to light (photophobia) and sound (phonophobia).

According to the International Classification of Headache Disorders, an individual must have at least five attacks per year to be diagnosed with migraine without aura.

The term aura refers to various symptoms that start approximately 30 minutes or so before the headache begins. The symptoms of aura are usually visual and may include such disturbances as seeing flashing lights or wavy lines, or losing part or all of your vision for a short period of time. Aura can sometimes include loss of the ability to speak, sensory disturbances (e.g., tingling or numbness), and motor problems (e.g., weakness in the extremities). 

Migraine with aura is less common than migraine without. It is also possible to experience aura without having a headache or any other symptoms afterward; this situation becomes more common as people get older. 

When migraines occur 15 or more days per month over a period of three months or more, the condition is called chronic, or transformed, migraine.

Over time people with episodic migraine may develop more and more headaches for various reasons, including changes in hormones, increased stress, illness, or an increase in the use of pain medications. Having more headaches decreases the threshold for new headaches, and the condition can become chronic and less responsive to medication. 

An abdominal migraine is a form of migraine seen mainly in children (most commonly those ages 5 to 9), but it can occur in adults as well.

Symptoms include abdominal pain, nausea, and vomiting. This is one type of migraine that usually doesn't involve a headache, although children who have abdominal migraines often have migraines involving head pain when they're older.

Simply put, an acephalgic or "silent" migraine is a migraine with many classic migraine symptoms, minus the characteristic headache. It's possible for some or all of your migraine attacks to manifest this way.

The most common symptoms of silent migraines are vision problems and alterations in color perception. Silent migraines are more common in people over 50 and are sometimes misdiagnosed as a stroke.

Formerly called basilar-type migraine, migraine with brainstem aura has symptoms that can be confused with those of a stroke, such as slurred speech, vertigo, unsteadiness, and numbness. As with migraine with aura, these symptoms come on gradually before the head pain of a migraine.

This type of migraine isn't common and seems to occur most frequently in adolescent girls.

Hemiplegic migraine is a rare form of a migraine that causes weakness on one side of the body, possibly accompanied by confusion or speech slurring. Like the symptoms of migraine with brainstem aura, hemiplegic migraine symptoms can be mistaken for stroke symptoms.

One subtype of a hemiplegic migraine runs in families, but you can have the condition without a family history.

A retinal migraine causes flashes or sparkles of light, possibly combined with partial or total temporary blindness, but only in one eye. This occurs before the headache phase of the migraine starts. The head pain generally commences within an hour of these visual symptoms and can last up to three days.

To diagnose a retinal migraine, your physician must rule out other possible blindness causes.

Status migrainosus is a painful, debilitating migraine attack lasting for more than 72 hours. If moderate to severe migraine pain lasts longer than this with less than a solid four-hour pain-free period while awake, it should be considered an emergency and warrants a trip to the emergency room.

Migraines of any type can be can be debilitating and isolating. When they occur frequently, they can interfere with your professional and personal life. Fortunately, treatments exist both to prevent migraines and treat them during an acute episode. If you are getting migraines consistently—or experience one of the rare types even once—consider seeing a neurologist who specializes in migraines and headaches.