A migraine is a disorder that causes moderate-to-severe headaches that occur in repeated episodes lasting between 4-72 hours1. Migraines are one of the most common neurological disorders, affecting over a billion people worldwide each year.
Although normal headaches can ruin your day, a migraine can stop you in your tracks, getting in the way of work, school, and daily life. If you experience migraines, understanding your condition is key to proper management and symptom relief. The first step to this is knowing what kind of migraines you have.
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Characterizations of Migraines
There are many different kinds of migraine disorders, each with its own set of symptoms, causes, and treatments.
Migraines With Auras vs. Without Auras
Migraines with auras, as the name implies, include the presence of sensory auras.1,3 These are most commonly visual, appearing as a blurry patch of the visual field that is often surrounded by a zigzagged, gleaming border called a scintillating scotoma.
However, auras are not always just visual. Sometimes they can be felt as a tingling sensation on the body, usually on one side of the face or a limb; this is called paresthesia. Some people experience audible auras that seem like ringing in the ears or noises that are not heard by others. Auras can also rarely manifest as language issues or motor symptoms.
The onset of an aura is usually gradual and lasts less than an hour, generally occurring just before the headache phase. Sometimes, however, they can manifest during the headache phase itself.
Although auras are one of the key defining features of migraine disorders, approximately 75 percent of migraines lack an aura phase.1 As a result, a major diagnostic criterion for migraines without auras is the absence of visible or sensory auras preceding the headache phase. However, other hallmark migraine phases are still present, and they can still be severely debilitating.
People living with chronic migraines experience more frequent migraines than those with other migraine conditions.1,4 To be diagnosed with chronic migraines, a person must have migraine headaches 15 or more days per month over a period of three or more months.
Vestibular migraines include symptoms of dizziness or vertigo in addition to the key hallmark symptoms of other migraine disorders.5 They are named after the vestibular system, which regulates the internal sense of balance and bodily motion. Vestibular migraines are one of the most common causes of vertigo.
People who suffer from abdominal migraines experience moderate to severe stomach pain instead of headache pain.6 While these kinds of migraines are common in childhood, affecting around 4 percent of children, they usually subside during adulthood. They are considered to be related to cyclical vomiting syndrome.
Cyclical Vomiting Syndrome
Cyclical vomiting syndrome is a kind of migraine where a person has episodes of violent vomiting, nausea, and tiredness.11 These episodes can last anywhere from one hour to over a week. They are related to abdominal migraines and can pose significant health concerns due to dehydration.
Migraine with Brainstem Aura (Basilar Migraine)
Also known as a basilar migraine, migraines with brainstem aura are characterized by vertigo, double-vision, auditory auras, and difficulty speaking, as well as a lack of motor coordination alongside the general sensory auras common to other migraine disorders.7
These kinds of migraines can be particularly scary, as they share the hallmark symptoms of stroke and certain kinds of brain tumors. However, like other migraine auras, these symptoms subside with the migraine.
Motor symptoms are rare in most migraine disorders. However, they are the key hallmark in hemiplegic migraines, occurring alongside more common aura symptoms.8 Hemiplegic migraines are relatively rare and usually run in families.
Motor symptoms in hemiplegic migraines usually take around half an hour to develop and last anywhere from a few hours to a couple of days. Much like migraines with brainstem auras, this disorder can mimic symptoms of a stroke.
Menstrual migraines occur in women and other people who menstruate.9 They are caused by a drop in estrogen during or just before a person’s period. As a result, diagnosing this kind of migraine requires keeping track of one’s menstrual cycle and migraine symptoms.
Medication Overuse Headache
Medication overuse headaches occur in people who take medications for pain relief, often for migraine or tension headaches.10 These headaches develop over time as a person takes more and more medication to relieve their headache pain from other conditions, eventually becoming the main cause of their headaches.
Pain medications that cause this condition include triptans, ergotamine, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and combination drugs that include opiates or barbiturates.
Sometimes called an ocular migraine, retinal migraines involve short periods where a person’s vision is repeatedly impaired or blinded in only one eye.12 These episodes usually occur before or during a headache phase, but not always.
If you experience visual disturbances from a single eye during your migraines, you should seek medical attention, as they can be a sign of more serious medical conditions.
Status migrainosus is a migraine headache that lasts longer than 72 hours, sometimes lasting for weeks.13 As one may expect, these migraines are particularly debilitating and cause significant mental distress in patients.
The long-lasting pain of status migrainosus can be so severe that some patients consider self-harm, so psychological support is crucial for this condition, in addition to other standard migraine treatments.
Ophthalmoplegic migraines are a kind of neurological disorder where a person experiences recurring episodes of headaches and ophthalmoplegia, a form of muscle weakness affecting the muscles that control eye movements.14
Contrary to the name, up to one-third of patients with the disorder do not have the kind of severe, prolonged headaches on one side of the head that characterize migraines. Instead, the pain is often primarily focused near the eyes. The loss of motor control of the eyes often results in double vision and pupils of different sizes.
Probable migraine is a term used to describe migraines that have all but one of the key clinical characteristics of migraine.15 In practice, this means they are usually less severe and last for a shorter time than a standard migraine but still follow the same classic set of migraine phases. Although probable migraines do not quite meet the clinical threshold of a migraine, they still cause significant pain and distress for those who experience them.
Types of Migraine Treatments
Migraine treatments vary between migraine conditions but are broadly divided into acute and prophylactic treatments.3
Acute therapies are taken during an episode to help relieve symptoms in the moment. They include NSAIDs like ibuprofen and aspirin, acetaminophen, triptans, antiemetics, ergots, steroids, and calcitonin-gene-related peptide agonists.
Prophylactic therapies are intended to prevent episodes or reduce their frequency. These drugs include beta-blockers, anti-depressants, anticonvulsants, and calcium channel blockers. Prophylactic treatments are meant to be taken consistently to be effective. Lifestyle changes like exercise, sleep hygiene, and dietary choices can also help reduce migraine episodes.
Migraines are a debilitating set of conditions that can drastically impair quality of life and the ability to go about one’s day. However, with proper diagnosis, you and your clinical team can develop a migraine management strategy that can give you symptom relief and help you live your life uninterrupted by the severe pain caused by migraines.