Types of Migraine

Migraine is classified by two major types — migraine with aura and migraine without aura. An aura is a group of changes that proceed a migraine headache, including visual, sensory, and cognitive changes. Both types share some common features, including a duration of roughly four to 72 hours and a one-sided, pulsating headache that worsens with even light physical activity.

Around 80 percent of migraineurs have migraine without aura, also called common migraine. Their headache begins without the “early warning system” of the aura. However, some people with this type of migraine may experience a prodrome — a group of physical and/or emotional symptoms occurring up to seventy-two hours before a migraine headache (see page 8 for more on prodromes).

The International Headache Society (IHS), a worldwide organization for clinicians involved with the study of headache, has established diagnostic guidelines for migraine that have been adapted by most health care practice organizations worldwide, including the American Academy of Neurology.

The IHS criteria for a diagnosis of migraine without aura is at least five attacks fulfilling the following:

  • Headache attacks lasting four to 72 hours (untreated or unsuccessfully treated)

  • Headache has at least two of the following characteristics:

    • Primarily felt on one side of the head (although referred pain may be felt anywhere on the face or head)

    • Pulsating or throbbing quality

    • Moderate to severe pain intensity

    • Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

  • During headache at least one of the following occurs:

    • Nausea and/or vomiting

    • Sensitivity to light and sound (photophobia and phonophobia)

  • Headache is not attributed to another neurological or physical disorder

Those patients who meet all the above criteria but have experienced fewer than five attacks are usually diagnosed with “probable migraine without aura.” Migraine attacks that occur for fifteen or more days of the month for at least three consecutive months are considered to be “chronic migraine without aura.”

Migraine with Aura

Migraine with aura is sometimes referred to as a classic migraine. The most common type of aura is visual. Migraine with aura is experienced by roughly 20 percent of all migraineurs.

The IHS criteria for a diagnosis of migraine with aura is at least two attacks fulfilling the following criteria:

  • Aura consisting of at least one of the following fully reversible symptoms, but no motor weakness:

    • Visual symptoms including positive features (e.g., flickering lights, spots, or lines) and/or negative features (i.e., loss of vision)

    • Sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)

    • Dysphasic speech disturbance (difficulty speaking)

  • At least two of the following:

    • Homonomous (affecting one-half of the visual fields of both eyes) visual symptoms and/or unilateral (or one sided) sensory symptoms (e.g., tingling of the arm)

    • At least one aura symptom develops gradually over five minutes and/or different aura symptoms occur in succession over five minutes

    • Each symptom lasts more than five and less than 60 minutes

  • Headache attacks lasting four to 72 hours (untreated or unsuccessfully treated) Headache begins during the aura or follows aura within 60 minutes and has at least two of the following characteristics:

    • Primarily felt on one side of the head (although referred pain may be felt anywhere on the face or head)

    • Pulsating or throbbing quality

    • Moderate to severe pain intensity

    • Aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)

  • During headache at least one of the following occurs:

    •Nausea and/or vomiting

    •Sensitivity to light and sound (photophobia and phonophobia)

  • Headache is not attributed to another disorder

There are some uncommon health conditions that may mimic migraine with aura. For this reason, your physician will take a complete health history and perform a physical and neurological exam to rule out other causes of aura and headache. The diagnostic process is described in detail in Chapter 3.

Less Common Types of Migraine

Finally, there are several less common classes of migraine that fall outside of the two major classes described previously. These are:

  • Basilar Migraine: A migraine with aura causing neurological dysfunction in the area of the brain supplied by the basilar artery, the brainstem. It has a specific aura profile, and the migraine pain affects both sides of the head.

  • Familial Hemiplegic Migraine: A severe but rare migraine with aura that causes weakness or paralysis on one side of the body and can result in coma.

  • Retinal (or Ocular) Migraine: A rare type of migraine associated with blindness or blurred vision in one eye for an extended period (to be distinguished from typical migraine aura which upon careful assessment involves the same points in the visual field of both eyes for five to 30 minutes).

  • Abdominal Migraine: Most common in children, abdominal migraine is characterized by bouts of abdominal pain, nausea, and vomiting that can last for up to 72 hours.

  • Migraine Aura Without Headache: In this type of migraine, the typical visual and neurological symptoms of aura occur, but there is no headache that follows.

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