10 Types of Migraine We Don't Talk About
When many people think of migraine, they probably associate it with really bad head pain – maybe even some nausea or light sensitivity, too. It’s often assumed that all migraine attacks look the same, when that couldn’t be further from the truth. While migraine is a neurological disease that can certainly cause classic symptoms like head pain or nausea, the reality is that there are many different types of migraine, each of which presents differently with its own unique set of symptoms. (For a complete breakdown of all the different migraine types and subtypes, you can check out the International Classification of Headache Disorders (ICHD-3), created by the International Headache Society.)
For those unfamiliar with the condition, the type of migraine that likely comes to mind when they think about migraine is migraine without aura – a migraine that causes symptoms such as head pain, nausea, sensitivity to light or sound, but no visual disturbances. This is by far the most common type, as 70 to 90 percent of those with migraine have it, though that certainly doesn’t mean it’s any less serious or debilitating.
We wanted to shine some light, however, on some of the less common types of migraine – the ones that perhaps don’t get as much exposure or recognition since they tend to be more rare. We asked our Mighty community which types of migraine we don’t talk about as often as we should, and why it’s important for us to raise awareness of them. Regardless of how common a certain migraine type is, we should be talking about all of them to demonstrate how diverse and varied migraine can be. This may not only help those with migraine be better understood and supported by friends and loved ones, but receive quicker diagnoses and more accurate treatment protocols from their doctors.
So without further ado, let’s talk migraine types:
1. Migraine With Aura
When a person is diagnosed with migraine, they typically fall into one of two main categories: migraine with aura, or migraine without aura (there are multiple types of migraine during which the aura stage can occur). An aura, sometimes known as a “warning sign,” is a series of sensory disturbances that happens before a migraine attack, and usually lasts for about 20-60 minutes. These may include vision disturbances (e.g. seeing flashes or stars), sensory changes (e.g. feeling tingling or numbness) or speech or language problems (e.g. slurring or being unable to produce the correct words). Only about 25 to 30 percent of people with migraine experience aura.
“Migraine with aura. And I mean visual aura. I can suddenly start having visual disturbances starting from the corner of my eye, moving closer inward, impairing my vision. Sometimes I will start to see blurry, then black spots in my entire field of vision until I have tunnel vision, then completely lose sight in one of my eyes for a few minutes. Imagine all the mistakes to be made if I am writing something important… even worse, if I am driving. No matter how many times I’ve had these visual disturbances, it scares me every single time!” – Gina F.
Did you know? People who have migraine with aura may be at an increased risk for stroke, especially women, and may have an increased tendency to form blood clots due to temporarily narrowed blood vessels. Always be sure to attend regular doctor appointments and health screenings.
The word “hemiplegia” refers to paralysis on one side of the body, so hemiplegic migraine refers to a type of migraine in which people experience temporary motor weakness or paralysis on one side of their body in addition to the migraine headache attack. For those with migraine, hemiplegia is actually a type of aura, so it may be accompanied by other aura symptoms such as vision changes, tingling, numbness or difficulty speaking. Hemiplegic migraine is divided into two types – familial hemiplegic migraine (it runs in the family) and sporadic hemiplegic migraine (it has occurred spontaneously in an individual) – and is a very rare form of migraine.
“I don’t think others understand that when I get these types of headaches I cannot move my left side at all. They are scary and I have been taken by EMS thinking I was having a stroke more than once.” – Susan D.
“The symptoms are scary to deal with and they come on so quickly. Also meds don’t seem to help as much.” – Brenlyn B.
Did you know? Hemiplegic migraine is the only type of migraine that has been scientifically confirmed to run in families.
3. Vestibular Migraine
The vestibular system, which includes parts of the inner ear and the brain, helps the body control balance and eye movements. With a vestibular migraine, a person experiences symptoms such as nausea, vomiting, dizziness, vertigo or lightheadedness, which may or may not accompany a headache. The condition affects approximately one percent of the population, while about 40 percent of those with migraine experience vestibular symptoms such as issues with balance or dizziness at some point, which may occur before, during, after or totally independent of a migraine attack.
“I have constant balance issues, unpredictable on-and-off vertigo, and had to go to a year of physical therapy to re-learn how to balance enough to do even the simplest of things. It can be utterly disabling and terrifying, both for the sufferer and for the people nearby. Plus, getting a diagnosis was anything but straightforward because it didn’t present as a ‘typical’ migraine.” – Megan S.
“The dizziness is terrible. Scary even. I have had the symptoms of migraines since I was a teenager but only recently started having vestibular migraines.” – Skye L.
Did you know? Many of the food and environmental triggers that vestibular migraine patients have are the same as those with non-migrainous vestibular dysfunction.
4. Chronic Migraine
According to headache experts, migraine attacks can be categorized into four different tiers of frequency, ranging from no migraine (zero days of migraine each month) to chronic migraine (15 migraine days of migraine each month). The International Headache Society requires that, in order to be diagnosed with chronic migraine, a person must experience a headache on 15 or more days per month for more than three months, which has features of a migraine headache on at least eight days per month. Chronic migraine occurs in about 1 percent of the population.
“People assume that a migraine is just a headache, but it is so much more, and when your condition is chronic you can suffer as much as 20+ days every month. Head pain is just one of so many awful symptoms and people don’t seem to know about the others – nausea, vomiting, dizziness, light and noise sensitivity, vertigo, visual disturbances, parasthesia, tinnitus, the list goes on. And with chronic migraine, you’re limited on how many abortive medications you can take each month, so even if you have 20 days of migraine, you may only be allowed to take six migraine relief tablets that month. Until people know that there are so many other symptoms that go along with the head pain, and the struggles with trying to treat them, migraines will never be properly understood by people who don’t suffer with them, which makes every day that much harder for us to get through.” – Lottie A.
Did you know? Migraine attacks may sometimes increase in frequency over time, for a number of reasons, though this can go unnoticed if it happens slowly, or if the patient only reports their most severe headaches. Keeping a headache diary or symptom tracker can help you and your doctor correctly identify and treat your condition.
5. Retinal Migraine
A retinal migraine is a rare type of migraine in which visual disturbances occur in only one eye. These may include scintillations (seeing twinkling lights), scotoma (areas of decreased or lost vision) or temporary blindness. The headache phase of the migraine typically begins during or within about an hour of the visual disturbances. Retinal migraine is different than migraine with aura because the visual disturbances are coming from the eye itself, rather than the brain, so they can only be seen with that one eye.
“I lose the sight in one of my eyes regularly and unpredictably. My eye feels like it’s going to fall out, stabbing and throbbing. I also suffer with chronic migraines on top of the ocular ones. They come on so suddenly, often with fatigue and nausea as a cue, with no trigger that I can put my finger on.” – Amy B.
Did you know? A retinal migraine is a type of ocular migraine, but the two terms are not interchangeable. An ocular migraine includes any migraine subtypes characterized by visual disturbances, including migraine with aura.
6. Abdominal Migraine
Abdominal migraine causes symptoms of abdominal pain, located in the center of the abdomen around the belly button, nausea, vomiting and loss of appetite. It occurs primarily in children ages 5 to 9, and while most grow out of it, they often go on to develop migraine headaches, or other types of migraine, in adulthood. Abdominal migraine affects approximately 2 percent of children, and is even rarer in adults.
“I spent years, thousands of dollars and an untold number of doctors trying to figure out what was wrong with me. None of the Mayo Clinic doctors knew. All of my testing came back negative and all of the doctors were baffled. I stumbled upon the term abdominal migraine and diagnosed myself. Now I take my migraine headache medication for my abdominal pain. And it works great. I was diagnosed with migraine headaches at age 5. Abdominal migraines started at age 40.” – Carousel A.
Did you know? Abdominal migraine can be difficult to diagnose due to the similarity in symptoms to many other conditions. In addition to the symptoms, the condition may be identified by the duration of the attacks, which last between two and 72 hours on average, and the complete remission from symptoms a person experiences in between attacks.
7. Migraine With Brainstem Aura
Migraine with brainstem aura is different than migraine with aura in that the aura symptoms originate from both the brainstem (the base of the brain) as well as the cerebral hemispheres (the sides of the brain) at the same time. A person may experience typical aura symptoms, such as seeing stars, or experiencing tingling or numbness, but they also get the different symptoms brainstem aura produces. These can include slurred speech, vertigo, tinnitus, hyperacusis (impaired hearing), double vision, ataxia (uncoordinated movement) and decreased level of consciousness, and typically don’t last more than an hour.
Did you know? Migraine with brainstem aura has formerly been known as basilar migraine, or basilar artery migraine, as it was believed the basilar artery was the origin of migraine attacks causing brainstem aura. However, it is now known that the nerves rather than the blood vessels are the cause of brainstem aura in migraine.
8. Silent Migraine
A silent migraine occurs when a person experiences any of the “typical” migraine symptoms (such as nausea, sensitivity to light or sound, aura, etc.) – but without any head pain. It’s important to note that a silent migraine is not officially classified as a “type” of migraine, as “silent” technically just refers to a phase of a migraine attack in which there is no headache. But while many of those with migraine may move through the four typical phases (prodrome, aura, headache, postdrome), some skip the headache phase and go through an entire migraine attack without experiencing any head pain.
Did you know? A silent migraine may be known by a number of different names, including acephalgic migraine, amigranous migraine, migraine aura without headache and migraine equivalent.
9. Menstrual Migraine
Menstrual migraine is a type of migraine that is linked to the timing of a woman’s menstrual cycle. The migraine attack usually occurs in the two days leading up to and the first three days of the period. While menstruation may be a migraine trigger for many women, menstrual migraine is a specific condition that affects less than 10 percent of women.
“Menstrual migraines: You know it’s coming, and there’s not much you can do to prevent it. Or migraines triggered by high humidity, storms, etc.” – Monica P.
Did you know? Menstrual migraine is thought to be caused by the drop in estrogen levels that occurs just before a woman’s period.
10. Intractable Migraine
Also known as status migrainosus or refractory migraine, an intractable migraine is a persistent type of migraine that doesn’t go away or respond to treatment. It occurs when a migraine lasts longer than 72 hours, even with treatment. They are typically very intense, causing symptoms such as nausea and dizziness in addition to head pain, and may require a hospital stay. Pain levels and symptoms may vary from day to day, but the migraine could last for months or years. Intractable migraine affects less than 1 percent of those with migraine.
“Chronic intractable migraine – a migraine that just keeps going and going and going. I have had this continuous brain pain for almost six months. Almost no pain medication helps and it has impacted every single area of my life.” – Ashley A.
“Intractable constant migraine, won’t go away regardless of treatment. Had the same attack for nearly five years and nothing touches it really apart from being stuck in the dark most of the time.” – Leanne H.
Did you know? Like all other forms of migraine, there is no cure or “one-size-fits-all” treatment for intractable migraine. It can take quite a bit of trial and error and working with different specialists to find medications, therapies, lifestyle changes or a combination thereof that can offer some relief.