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Types of Migraine

By
Contributors: Lawrence C. Newman, MD, David Dodick, MD, Michael Teixido, MD, Stephen Silberstein, MD, Christina Treppendahl, FNP-BC, AQH, MHD
Last Reviewed:

Migraine disease can be debilitating and often difficult to manage. It can present as many different types and vary in symptoms, frequency (from episodic to chronic), and intensity. Learning if you have migraine in the first place, and, second, what type you have, can help guide you to the appropriate health care provider and a constructive treatment plan.

Table of Contents
  1. Introduction
  2. Not Sure If You Have a Migraine Disorder?
  3. Migraine vs. Tension-Type Headache
  4. The Different Migraine Types 
  5. Summary
  6. Links to Resources

Introduction

Migraine disease can be debilitating and often difficult to manage. It can present as many different types and vary in symptoms, frequency (from episodic to chronic), and intensity. Learning if you have migraine in the first place, and, second, what type you have, can help guide you to the appropriate health care provider and a constructive treatment plan.

Not Sure If You Have a Migraine Disorder?

Below is a screening tool to help you determine if what you are experiencing is migraine.

Screening Tool: Headache vs. Migraine

Migraine vs. Tension-Type Headache

Migraine is more than just a headache. It is a neurological (related to the brain) disorder influenced by genetic and environmental factors. It can include symptoms such as light or noise sensitivity, nausea, vomiting, dizziness, stomach pain, brain fog, and much more. Together, these symptoms form what practitioners call a migraine “attack,” which can interfere with a person’s daily activities and significantly disrupt their way of life.

“So we know the diagnostic criteria for migraine, which is one-sided pain, throbbing pain, moderate to severe pain, pain that worsens with routine activity, plus one of the following: either nausea or vomiting, or light or sound sensitivity. But when we talk about tension-type headache, it’s the opposite.”
— Dr. Lawrence Newman, professor of neurology

Dr. Newman further explains tension-type headache: “It’s pain on both sides of the head, it’s non-throbbing pain, it’s mild or moderate pain, and it’s not disabling. And in clinical practice, doctors who treat people with headache look at it as a headache without any associated features. It’s just the head pain.”1

Migraine
Tension Headache

Head Pain Location
Often One-Sided 
Always Bilateral 
Intensity
Moderate to Severe, Disabling
Mild to Moderate
Duration
4-72 Hours
30 minutes-1 day
Symptoms
Headache; Sensitivity to Light, Sounds, and Smells;
Nausea; Fatigue; Brain Fog and More
Head Pain

Watch or listen to Dr. David Dodick, professor emeritus at the Mayo Clinic, further describe what is happening in the brain during a migraine attack.

Migraine Statistics

  • Migraine occurs in both children and adults.
  • Migraine is 3X more common in women than in men.
  • Migraine is more common than diabetes, epilepsy, and asthma combined.
  • Migraine affects more than a billion people globally and is the second most common cause of years of disability.2
  • Approximately 50% of migraine disease is linked to genetics, the other 50% to environmental factors.
  • Most individuals with migraine have a family history of the disease.
  • Individuals with underlying medical conditions such as epilepsy, sleep disorders, and mood disorders are more likely to develop migraine disease.

The Different Migraine Types 

Migraine With Aura (Classic Migraine)

Migraine with aura, also known as classic migraine, is a type of migraine where a person experiences a “warning sign,” or aura, before the actual head pain begins. Aura can present visually in the form of seeing flashing lights or zigzag patterns. Auras may also bring speech disturbances; numbness, tingling or weakness in the body; nausea; loss of appetite; confusion; blurred vision; mood changes; and fatigue. This often coincides with increased sensitivity to light, noise, or sound.

Most aura symptoms are reversible and resolve within an hour. The most common aura symptoms are visual disturbances, which can last up to 60 minutes and then settle. Anyone who experiences an aura that lasts over an hour should seek immediate medical care, in order to rule out something more serious.3

To learn more about migraine with aura, click the following link:
https://migraineworldsummit.com/migraine-with-aura/.

Migraine Without Aura (Common Migraine)

Migraine without aura, also known as common migraine, is a type of migraine with moderate to severe episodes of head pain without aura symptoms. Head pain can be on one side or both, and is usually worse with physical activity. This form is a more frequent type of migraine and occurs without warning. It can include symptoms like nausea, vomiting, confusion, blurred vision, mood changes, fatigue, and increased sensitivity to sound, light, or noise.

Chronic Migraine

The International Headache Society defines chronic migraine as experiencing headache on 15 or more days per month for more than three months, where at least eight of those headache days have migraine features. Again, those features include things like nausea, vomiting, sensitivity to light or sound, and moderate to severe headache that is described as throbbing or pulsing.

It is estimated that 3-5% of the U.S. population experiences chronic migraine.4 Further statistics show 2.5 out of 100 episodic migraine patients will develop chronic migraine.

Characteristics
  • These migraine attacks start 2-3 days before a woman’s period to the 3rd day of menstrual flow.
  • For women with migraine, 60% report their attacks occur at the same time as their menstrual cycle.
  • Menstrual migraine attacks are more severe and lengthier than attacks during other times of the month.
  • These attacks are caused by a rapid drop in estrogen levels, which occurs right before a period.
  • This type can be challenging to treat and sometimes doesn’t respond to typical migraine therapies.
  • Menstrually related migraine occurs when patients have both menstrual migraine and another type of migraine, like migraine with aura, occurring at other times during the month.5

Vestibular Migraine (Migraine-Associated Vertigo)

Vestibular Migraine is a migraine type in which the prominent symptom is vertigo or dizziness. Individuals with vestibular migraine describe this as a sensation of rocking back and forth, spinning, moving while their body is still — or a sudden dropping sensation while sitting still. Patients with vestibular migraine don’t always have a headache with their migraine attack; however, they usually have other migraine symptoms like light or sound sensitivity and nausea. Some vestibular patients have a history of motion sickness or sensitivity beginning in childhood. In adults, vestibular migraine is the second most common cause of vertigo.6 To take a more extensive look at vestibular migraine, explore our in-depth article on this migraine type.

“… I am looking at you now, and looking at my room, but imagine you feel that you’re really looking at the world from about a foot or two behind where you are — an out-of-body displacement. We call that ‘Alice in Wonderland’ syndrome. Those are symptoms that generate from abnormalities of [the] processing of normal vestibular information in the brain that comes from the inner ears.”7
— Dr. Michael Teixido

Abdominal Migraine

Abdominal migraine is a type of migraine in which the patient experiences episodic, central abdominal pain along with other features of migraine. These can include nausea, vomiting, loss of appetite, and a pale complexion in the face. This type usually starts in childhood, with the average onset at age 7, but it can occur in adults, typically with a family history of migraine. Abdominal migraine is more common in girls than boys. Most people with abdominal migraine feel well between attacks.8

By their teenage years, 60% of kids who experienced abdominal migraine will outgrow their abdominal pain. Yet up to 70% of those with abdominal migraine can develop typical migraine as adults. To learn more about abdominal migraine, check out our in-depth look at this migraine type. 



Hemiplegic Migraine

This is a rare form of migraine that along with other migraine symptoms includes weakness on one side of the body (hemiplegia). People with hemiplegic migraine may or may not have head pain during their attacks. Symptoms can last from hours to days. This type of migraine often begins in childhood and runs in families. Hemiplegic migraine can present like a stroke, so it is important to be evaluated by a healthcare provider to get a clear diagnosis through testing and imaging studies.9

Dr. Stephen Silberstein discussed this rare form of migraine at the Migraine World Summit:

“There are two types of hemiplegic migraine. One is the type that’s genetic and runs in families, which means you have a relative with it. The second type is (what) we call sporadic hemiplegic migraine, which means you don’t have a first-degree relative with it. Hemiplegic migraine is really defined by the fact that during the aura, or the neurological symptoms that precede the migraine attack, the patient is weak on one side of the body.”10
— Dr. Stephen Silberstein 

Migraine With Brainstem Aura (Formerly Basilar-Type Migraine)

Ten percent of people who experience migraine with aura will be diagnosed with migraine with brainstem aura. Individuals that have migraine with brainstem aura may also deal with vertigo, dizziness, slurred speech, ringing in the ears, and double vision. These symptoms develop gradually from the area in the brain called the brainstem and can happen before or during a typical migraine headache. Migraine with brainstem aura usually occurs during adulthood; however, it can occur at any age. Features can also include disorientation or confusion as well as temporary loss of consciousness, which is known as syncope.11

“The reason we called it migraine with brainstem aura is because of the symptoms that these patients have. They have double vision. They slur their speech, like they’ve had too much to drink. They’re unsteady on their feet. They have vertigo. Sometimes they have numbness and tingling, but on both sides of the body.12
— Dr. David Dodick

Retinal Migraine

Characteristics
  • These attacks cause temporary loss of vision in one eye and are followed by a headache within an hour.
  • The loss of vision is reversible.
  • This form is most common in women of childbearing years.
  • Vision loss can last up to anywhere between 5-60 minutes.
  • This typically occurs in one eye.
  • Retinal migraine is a rare type of migraine and often confused with ocular migraine. Headache specialists now use migraine with aura interchangeably to describe ocular migraine.
  • Other issues with the eye should be ruled out before retinal migraine is diagnosed.13

Migraine Aura Without Headache (Formerly Known as Silent Migraine or Acephalgic Migraine)

Experts refer to this type as a migraine attack with aura but no headache pain. It is a rare type and is currently known as migraine aura without headache. Only 3-4% of patients with migraine have migraine aura without headache. An individual’s, often debilitating, aura can include temporary language, speech, and visual disturbances — typically lasting for under an hour. Individuals can be triggered by typical migraine triggers and often experience other types of migraine as well. Treatment for individuals with migraine aura without headache can be extremely challenging.14

Status Migrainosus or Status Migraine

Status migrainosus, or status migraine, is a type of migraine where an attack can last for days or weeks and does not respond to treatment. This migraine type is one of the most difficult to treat. Individuals with status migraine have a history of migraine, either migraine with or without aura. People with chronic migraine, obesity, lower socioeconomic status, lack of access to quality healthcare, and struggles with mental health are at higher risk of status migraine. It is also thought that individuals who have migraine disorder but are not on a preventive migraine medication are more at risk.

Allow Christina Treppendahl, FNP-BC, AWH, MHD, to explain status migraine biology. 

“ … you get this peripheral sensitization at first, with something that triggers a migraine. You get peripheral sensitization, and that’s outside the central nervous system. And then the neurons in the meninges send signals to your deep brain to kind of have an autoplay of more pain, more pain, more pain, more pain. And so you get into what we call this central sensitization, where the brain does not know how to shut that off.”15 
Christina Treppendahl

Summary

Understanding the different types of migraine can be overwhelming initially. The first and crucial step to healing is often finding the correct diagnosis. Regardless of migraine type, finding the appropriate healthcare provider can be instrumental in receiving the best migraine treatments for you. If possible, it is important to seek out a headache specialist, or neurologist who regularly treats migraines, for evaluation and treatment. Working with a specialist will reveal the many migraine treatment options and therapies that can assist you while living with migraine.

The Migraine World Summit is here to help. Visit our website to find links to provider directories and migraine support groups. The Migraine World Summit can help educate you and give you the power to improve your quality of life one step at a time.

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MIGRAINE SUPPORT GROUPS

Links to outside organizations and articles are provided for informational purposes only and imply no endorsement on behalf of the Migraine World Summit.

Author: Editorial Team

The Migraine World Summit Editorial Team are made up writers, reviewers and publishers who carefully review the information provided by our experts and share those insights in these in-depth articles.

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