What are the Different Types of Migraine? 2024
The subject of migraine is confusing, mainly because there are so many technical terms attached to the word, “migraine.” What does it all mean?
Migraine affects 12% of the world's population, including 25% of women and 5% of men. It often starts in childhood and then rises to become a life-long repetitive, persistent, sometimes disabling medical problem. For some women it starts around menopause, a difficult time for many women, so that moderate to severe headache is added to the cramping, bloody, hot flash time of a woman’s life.
Why are there all these different types of migraine headaches? This article presents a list and short discussion of the different types of Migraine.
This is an article by Britt Talley Daniel MD, retired member of the American Academy of Neurology, Migraine textbook author, Podcaster, YouTube video producer, and Blogger.
Read my mini eBook on Migraine. Click Here
Different types of migraine headaches
Migraine without aura
Migraine with aura
Menstrually related migraine with or without aura
Pure Menstrual Migraine
Vestibular migraine
Abdominal migraine
Familial Hemiplegic migraine
Retinal migraine
Ocular migraine
Migraine with brainstem aura
Chronic Migraine
Episodic Migraine
Status migrainosus.
Weekend Migraines
Confusional Migraine
Footballer’s Migraine
Migraine aura-triggered seizure
Persistent aura without infarction
Silent, acephalic, Migraine.
Migraine without aura
This type is two thirds of the total migraine group and used to be called “common migraine” probably it was just a plain old regular migraine type headache with the following symptoms:
One-sided headache for the majority or about 80%
Headache is moderate (level 5/10) to severe (10/10) on a scale of 1 to 10
Headache duration is 4 to 72 hours
Throbbing headache, like you feel your heartbeat in your head
Headache comes with nausea in 70% and vomiting in 60%
Headache comes with sensitivity to light (photophobia) and sound (sonophobia)
Headache makes the affected victim want to lie down and do nothing as being up and being active makes the headache experience worse.
Migraine with aura
Persons with migraine with aura have similar migraine features as listed above. This type of migraine used to be called “classical” migraine.
About one third of the total migraine group have migraine with aura
Migraine aura symptoms last usually 10 to 60 minutes only. The visual auras last 10 to 20 minutes usually.
The aura refers to a usual premonitory warning, or aura before headache onset. The aura part may also come in the middle of a headache or at the end of a headache, in which the aura term is not relevant.
The visual aura consists of seeing moving zigzag lines in both visual fields which is more prominent on one side, although it is in both eyes, and is homonomous. The aura may be seeing half of things, bright dots, or spots which move, or blank spots where visual information may be lacking (scotoma).
Sometimes with the visual aura the person may have a prickling numbness which starts in the fingers of one hand and that then marches across the fingers individually and rises to the forearm and then is especially felt in the cheek and tongue on the same side.
Rarely for the migraine with aura person there may be a disturbance of speech wherein it is difficult to talk or read normally for a few minutes followed by good recovery. This is called aphasia.
Read my article, Migraine with aura, at www.doctormigraine.com
Migrainous aura
Menstrually related migraine with or without aura
This is when the migraine headache links to a woman's period coming the day of menstrual onset or 2 days before or after menstrual onset. The migraine here has the typical features of migraine with or without aura and comes during the menstrual cycle time and at other intervals during the month.
Pure Menstrual Migraine
This term refers to women who only have their migraines at the time of their menstruation but not at other times during the month. For women, the migraines that occur with menstruation are usually their longest and most severe migraine of all.
Migraine and pregnancy
Vestibular migraine
Vertigo comes from Latin and means “to turn” and feels like getting off a spinning merry go round at the playground. During vertigo a person is sitting still and feels as if the world around him is spinning or moving.
About 40% of persons with migraine may also experience vertigo. Vestibular migraine (VM) is a neurological condition that may come with or without migraine headache where the person experiences vertigo, dizziness, or an off-balance feeling. Vestibular migraine runs in families.
Dizzy
Abdominal migraine
Abdominal Migraine is gastrointestinal or vasomotor, autonomic nervous system induced symptoms which occur in patients usually in the second decade of life, between 11 and 20 years old.
Patients complain of nausea, vomiting, stomach cramping, anorexia, and vague centrally located abdominal pain around the umbilicus. It is not associated with severe migraine headache but may come with mild or no headache at this young age
Like adult migraine which occurs three times more often in women than men, more young adolescent girls have abdominal migraine than men. Then later in the twenties the GI symptoms and mild headache turns into more typical migraine with severe one-sided headache, sensitivity to light and sound and nausea and vomiting.
Abdominal migraine usually turns into migraine with ageing.
Abdominal Migraine
Familial Hemiplegic Migraine
Familial Hemiplegic Migraine is migraine with aura which includes motor weakness and at least one first or second degree relative who has migraine aura with motor weakness.]
The International Classification of Headache Disorders v. 3 (ICHD) requires two attacks of motor weakness with visual aura symptoms, sensory-pins and needles type numbness, or speech symptoms.
The aura symptoms should last longer than 5 minutes and less than 24 hours.
Typical migraine headache should begin within 60 minutes of aura onset and last 4-72 hours.
Ocular Migraine
This term is a misnomer, and is not listed in the ICHD. Most persons are thinking of migraine with aura type of visual events or retinal migraine when this term is used, and many non-neurologically trained doctors also mistakenly use it.
Other terms along these lines are Opthalmoplegic Migraine which was in the first international headache classification but now the ophthalmoplegia (eye movement paralysis) has been found to occur with many other neurologic conditions than migraine.
Also, there is no specific Ophthalmic migraine which is not in the ICHD.
Retinal migraine
Light enters the eye through the pupil, goes to the retina, and then curses dorsally through the optic nerve and the optic radiations to the back of the brain, in the occipital lobe. The visual workings of migraine are usually in the back of the brain, in the occipital lobe, but retinal migraine must occur in in the back of the eye.
ICHD requires the patient to have experienced repeated attacks of migraine with aura and then:
aura characterized by both of the following-fully reversible, monocular, positive and/or negative visual phenomena (e.g., scintillations, scotomata, or blindness) confirmed during an attack by either or both of the following:
clinical visual field examination
the patient’s drawing of a monocular field defect (made after clear instruction)
at least two of the following:
spreading gradually over ≥5 minutes
symptoms last 5-60 minutes
accompanied, or followed within 60 minutes, by headache
Not better accounted for by another ICHD-3 diagnosis, and other causes of amaurosis fugax have been excluded.
Some patients who complain of monocular visual disturbance in fact have hemianopia (visual loss in the same part of both the right and left eye, such as right eye nasal loss, left eye temporal loss.) Hemianopia originates in the back of the brain in the occipital lobe. Some cases without headache have been reported, but migraine as the underlying aetiology in those cases cannot be ascertained.
Retinal migraine is an extremely rare cause of transient monocular visual loss. Cases of permanent monocular visual loss associated with migraine have been described. Appropriate investigations are required to exclude other causes of transient monocular blindness.
Retinal migraine is a migraine visual aura occurring just in one eye, or in what may be referred to as a “monocular” distribution rather than the usual bilateral, homonymous pattern.
In a homonymous pattern the observant and carefully instructed patient may notice the visual aura in, for example, the left halves of both eyes. The visual aura should be followed by a typical migraine without aura headache.
Read my article “Retinal Migraine” at www.doctormigraine.com.
Migraine with brainstem aura
Migraine with Brainstem Aura is a type of migraine with aura attack with symptoms from the brainstem causing headache on the back of the head and visual auras and numbness and tingling on both sides of the body, left and right.
According to the International Classification of Headache Disorders V 3 (ICHD 3) Migraine with brainstem aura (MBA) has the following features:
It occurs with neurological symptoms that would include at least two of the following:
slurring of speech (dysarthria)
a sensation of movement (vertigo)
ringing in the ears (tinnitus)
double vision (diplopia)
Unsteadiness when walking as if drunk (ataxia)
Temporary decreased consciousness (syncope)
Pins and needles and /or numbness affecting both arms and/or legs
Changes in eyesight in both eyes such as patterns or flashing lights
Migraine with brainstem aura symptoms often develop gradually and occur with or before a typical migraine headache in those who experience it.
Migraine with brainstem aura occurs in about 1 in 10 people who get migraine with typical visual aura. Vertigo, dizziness, slurred speech, ringing in the ears and double vision also commonly occur.
Some people experience disorientation or confusion as well as temporary loss of consciousness, known as syncope.
Brainstem
Chronic Migraine
Chronic migraine is defined as having 15 or more headaches in a month’s time, 8 of which have the features of migraine, occurring for 3 months in a row. Most persons with Chronic Migraine are overtreating with painkillers, narcotics, caffeine, or barbiturate drugs and also have medication overuse headache.
Episodic Migraine
Episodic Migraine is defined as having 14 or less migraine headaches in a month.
Status Migrainosus
A migraine that lasts for more than 72 hours is called status migrainosus.
The usual time for a migraine is 4 to 5 hours, but status migrainosus is named for attacks that last 72 hours or longer. This type of migraine obviously does not respond well to treatment, or they would have stopped earlier.
All migraine patients should be counselled to treat their headaches at the onset with one of the triptans, which are still the best drug for acute migraine treatment, but 70% of persons with migraine have never had a diagnosis of migraine made by a doctor or given a prescription for more effective migraine treatment than something over the counter, like Excedrin,
Status migrainosus occurs more frequently in persons with chronic migraine from medication overuse headache and is a headache that quickly gets out of control and is hard to treat.
Weekend Migraine
Migraines tend to occur either during stressful times or with reduction of stress, as on the weekend where you can sleep in later, eat breakfast later, drink your 2 cups of coffee later, and relax for a down weekend at the end of a stressful week.
Then “Bam” your weekend headache greets you under the covers while you are still sleeping in and definitely not ready for it. The terms “Saturday morning headache” and “Sunday morning headache” relate to similar migraine situations-free from stress.
Acute Confusional Migraine
Acute Confusional Migraine (ACM) is the development of acute altered sensorium with confusion, irritability, drowsiness, nausea, or vomiting following mild non-concussive head injury. It primarily affects only children and adolescents.
Although migraine has been studied since Hippocrates mentioned “sick headache” in 400 BC and Galen described “hemicrania” in AD 200, Acute Confusional Migraine is in the beginning stage of medical research. Few case studies appear in the medical literature.
Researchers have recommended that ACMs be added to the official International Classification of Headache Disorders as a “migraine variant.” This hasn’t happened yet, but writers of this opinion think unity with ICHD-3 may help pediatricians and others more easily recognize this type of migraine.
At times confusional migraine may occur spontaneously. Most of the patients have throbbing headache when they recover enough to describe how they feel and go on to develop migraine later in life. There is an increased history of migraine in the family of affected patients.
Tests such as CAT or MRI scan of the brain are normal although the EEG is typically slow during the attack and becomes normal after recovery. The syndrome occurs mostly in young children or adolescents who remain amnestic for what happened after the event. Occasional patients may have recurrent attacks.
Acute care physicians should have ACM in their differential diagnosis along with the other possible and more concerning neurologic diseases such as subdural, epidural, or subarachnoid hemorrhage, meningitis, nonconvulsive seizure, postictal state, or metabolic disorder.
Footballer’s Migraine
What has come to be called “Footballer’s Migraine” is really a syndrome of symptoms of fortification visual images, numbness and paresthesiae usually one on side of the body in the arm and face, and rare hemiparesis followed by throbbing headache, much like that of an attack of migraine with aura.
These events occur minutes after mild, usually non-concussive head trauma such as may be sustained in soccer, boxing, or mild accidental head trauma. Many of the patients may have spontaneous typical migraine before or after the traumatic event and most of them have a history of migraine in their family. “Footballer” in this sense refers to a soccer player, not an American type of football player. Footballer’s Migraine is not mentioned in ICDH-3.
Cortical Spreading Depression. The current view of the pathophysiologic changes in these patients with Footballer’s Migraine is that trauma induces Leao’s Cortical Spreading Depression, a reaction of neuronal and glial depolarization which passes like a wave over the cerebral cortex and then resets.
Read my article on “Footballer’s Migraine” at www.doctormigraine.com.
Migraine aura-triggered seizure
Migraine and epilepsy are prototypical examples of paroxysmal brain disorders. While migraine-like headaches are quite frequently seen in the epileptic postictal period, sometimes a seizure occurs during or following a migraine with aura attack.
This may be referred to as migralepsy, a rare event, originally described in patients with Migraine with aura. Evidence for association with Migraine without aura is still lacking.
This is an epileptic seizure occurring during or within an hour after an attack of migraine with aura event Migraine and epilepsy are comorbid, episodic paroxysmal disorders.
Persistent aura without infarction
Very rarely a patient with migraine with aura will experience a persistent visual aura. This is a rare but well documented condition. There should be persistence of a migraine aura for more than one week without neuroimaging evidence of infarction. There is no stroke. The auras are usually present in bilateral visual fields, in central vision, and superimposed on normal vision.
Silent, Acephalic, Migraine
This is the occurrence usually in middle aged to older women of events of typical visual migrainous auras lasting the usual 10 to 20 minutes. Often this occurs in women who have had very mild migraine without aura attacks or migraine like attacks such as menstrual headaches, hungry headaches, nocturnal headaches, or weekend let-down type headaches previously.
These women have usually never seen a doctor before for headache or migraine because their experience had been only of trivial, easily treated headaches. Sometimes men are affected with this.
The occurrence of the visual aura typical of migraine, however, does marks them as a person with Migraine.
Read my big book on Migraine. Click Here
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All the best.
Britt Talley Daniel MD