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Migraine Types

Abdominal Migraine

Abdominal migraine is one of the variants of migraine headache. It is also known by other terms including "periodic syndrome". This variant most typically occurs in children. They usually have a family history of migraine and go on to develop typical migraine later in their life.

The attacks are characterized by periodic bouts of moderate to severe midline abdominal pain lasting for 1 to 72 hours. Along with the abdominal pain they may have other symptoms such as nausea and vomiting, flushing or pallor. Tests fail to reveal a gastro-intestinal cause for the pain. Medications that are useful for treating migraine work to control these attacks in most children including daily preventive medications and anti-nausea medications to take during the attack.

Basilar Migraine

This type of headache is a rare form of migraine with aura. The aura symptoms come from the brainstem or both sides of the brain. Whether or not the basilar artery to the back of the brain is involved is uncertain. It most commonly occurs in young adults.

The aura symptoms can include dizziness, double vision, loss of balance, confusion, slurred speech, hearing changes and tingling on both sides of the body. During the attack, some people lose consciousness or pass out. The aura typically lasts less than one hour. Often these patients are mistakenly thought to be intoxicated, under the influence of drugs, or suffering from other conditions. There is usually no weakness associated with these attacks. The headache that follows is typical of migraine headache.

A previous history of migraine is helpful in making the diagnosis.

Complicated Migraine

The term "complicated migraine" is no longer used. It commonly referred to attacks of prolonged aura symptoms that could last hours to days or opthalmoplegic migraine where patients developed a partial or complete paralysis of the nerves that are needed for eye movement.

Other unusual types of migraine with aura include hemiplegic migraine and basilar type migraine. Familial hemiplegic migraine can be inherited and has been linked to one of several chromosomes. During attacks, patients develop stroke-like symptoms with sensory and/or loss of strength of muscles. Rarely, this type of migraine occurs without a family history. In basilar-type migraine, patients have migraine aura with neurological symptoms related to the base of the brain called the brainstem, including dizziness, hearing changes and visual disturbance. Unlike migraine with typical aura where numbness can occur on one side of the body, in this form both sides are affected. Sometimes, patients will loose consciousness or pass out with these headaches.

Another form of migraine is retinal migraine where the patient's visual symptoms occur in only one eye, stemming from the retina itself versus the portion of the brain involved in vision, as is the case for the typical migraine aura.

Migraine can also be associated with serious results such as aura lasting longer than a week with or without brain infarction (stroke), and migraine-triggered seizures.

Patients with these types of unusual migraines should be evaluated and treated by a specialist. Because the cause of these migraine types is not fully understood, patients with these symptoms should not use triptans for acute treatment.

Cyclic Migraine Syndrome

Patients with cyclic migraine usually experience ten or more attacks per month. These headaches differ from cluster in that they are long lasting and do not have associated typical cluster symptoms. Patients do have typical migraine symptoms during these headaches. It has been shown that lithium carbonate is of some help in these cases. Careful monitoring of the blood level and of thyroid function is needed with this medication.

Hemiplegic Migraine

This is a very rare form of migraine that is considered to be one of the more severe types of migraine. The sufferer may develop some temporary motor paralysis and/or sensory disturbances on one side of the body, immediately followed by the headache. This may be accompanied by numbness or a pins-and-needles sensation. The neurological symptoms usually leave when the headache appears.

With hemiplegic migraine, there is often a familial occurrence. In about 50% of these families, a chromosome defect may be found on chromosome 19 or on chromosome 1 and involves abnormal calcium channels. A physician should be consulted for this type of headache. You should not take triptans if you have this type of headache.

Nocturnal Migraine

Many patients who have migraine will experience their attacks during the middle of the night or early morning hours. This headache often awakens the patient from sleep.

Recent evidence suggests that these attacks are related to changes in neurotransmitters in the brain during sleep. It is recommended that patients treat the headache when the attack begins, elevate their upper torso (back, shoulders, and head) and rest or try to go back to sleep.

Ophthalmoplegic Migraine

Ophthalmoplegic migraine is a rare condition considered to be an unusual form of migraine.

The pain usually surrounds the eyeball and lasts from a few days to a few months, caused by weakness of the muscles surrounding the eye. It is important to confirm the diagnosis of ophthalmoplegic migraine, as similar symptoms can be caused by pressure on the nerves behind the eye.

Pregnancy and Migraine

Approximately 80% of women who have migraine stop having migraine attacks from the end of the third month of pregnancy until delivery. This is believed to be due to hormonal stability.

During pregnancy, medication use is discouraged unless absolutely necessary. Before using any medication for headache, a physician should be consulted. A non-medicinal treatment program can be effective in pregnancy.

Excerpted and used with permission of the National Headache Foundation

Last updated July 8, 2010




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