Types of Migraines

Personally I get several types of migraines (as well as other types of headaches). I am on a waiting list for a headache specialist here in Seattle and keep track of the types of migraines I get in my daily headache journal. Hopefully this will help identify if there are other primary causes for some of my pain.

TYPES OF MIGRAINES

Complicated Migraine. The aura of migraine typically lasts from 20 minutes to an hour. Some patients have prolonged aura symptoms that can last hours to days. The aura also typically ends before the headache itself begins. When migraine aura symptoms are prolonged or last into or through the headache phase these types of migraine are commonly referred to as complicated migraines. There are several forms of these complicated migraine attacks. There is ophthalmoplegic migraine where patients develop a partial or complete paralysis of the nerves that are needed for eye movement. There is retinal migraine where the patient's visual symptoms occur from the retina itself versus the portion of the brain involved in vision, as is the case for the typical migraine aura. There is hemiplegic migraine, which can be inherited and has been linked to one of several chromosomes. Patients develop stroke-like symptoms with sensory and/or loss of strength of muscles. There is basilar migraine, which used to be called Bickerstaff's syndrome. Here patients start with a typical migraine aura then progress to developing neurological symptoms related to the bases of the brain called the brainstem. Unlike typical migraine attacks where numbness can occur on one side of the body in this form both sides are affected. The headaches in basilar migraine are often at the back of the head and may result in very severe vomiting.

Hemiplegic migraine. Temporary paralysis (hemiplegia) or nerve or sensory changes on one side of the body (such as muscle weakness). The onset of the headache may be associated with temporary numbness, dizziness, or vision changes. These need to be differentiated from a stroke.

Ocular Migraine. Ocular migraine is a term which may have different meanings to different physicians. Many times, migraineurs will have just the visual warning signs or aura of their migraine attack without the headache. This occurs more frequently as one gets older and can be a frightening phenomenon. This is also referred to as acephalgic migraine, or migraine aura without headache. Some physicians refer to ocular migraine as retinal migraine, where there are repeated attacks of one-sided blind spots or blindness lasting less than an hour and associated with a headache. It is important to rule out eye disease or a disorder of the blood vessels leading to the eye as possible causes.

Exertion Migraine. This is normally a short lived migraine brought on by physical exercise (combined with dehydration), exertion through lifting or sometimes it can even be caused by a fit of sneezing or bending over.

Retinal migraine. Temporary, partial or complete loss of vision in one eye, along with a dull ache behind the eye that may spread to the rest of the head.

Basilar artery migraine. Dizziness, confusion or loss of balance can precede the headache. The headache pain may affect the back of the head. These symptoms usually occur suddenly and can be associated with the inability to speak properly, ringing in the ears, and vomiting. This type of migraine is strongly related to hormonal changes and primarily affects young adult women.

Status migrainosus. A rare and severe type of migraine that can last 72-hours or longer. The pain and nausea are so intense that people who have this type of headache often need to be hospitalized. Certain medications, or medication withdrawal, can cause this type migraine syndrome.

Ophthalmoplegic migraine. Pain around the eye, including paralysis in the muscles surrounding the eye. This is an emergency medical condition, as the symptoms can also be caused by pressure on the nerves behind the eye or an aneurysm. Other symptoms of ophthalmoplegic migraines include droopy eyelid, double vision, or other vision changes. Fortunately, this is a rare form of migraine.

Nocturnal Migraine. Many patients who have migraine will experience their attacks during the early morning hours, most commonly around 4:00 A.M. This headache often awakens the patient. Recent evidence suggests that these attacks are related to changes in adrenalin and related substances that occur on a cyclical basis, and which reach their peak release during these hours. Alteration in sleep cycles may also provoke migraine attacks. When sleeping beyond the normal wakeup time, a patient may be awakened by a migraine attack.

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 level of the medication in the blood and of thyroid functioning is needed with this medication.

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 abdominal pain lasting for about two hours. Along with the abdominal pain they may have other symptoms such as nausea and vomiting, flushing or pallor. Tests fail to reveal a cause for the pain. Occasionally there may be EEG findings suggestive of epilepsy but this is rarely related to seizures. Medications that are useful for treating migraine work to control these attacks in most children.

I also find this website really helpful - talks about the anatomy of migraines. I am stuck in the cycle and use it as a great starting point for recognizing where I am in my migraine cycle.

7/20/08: Found this great site that gives a wonderful breakdown of the different types of migraines : http://www.healthcentral.com/migraine/types-of-headaches.html