Migraines can be scary, particularly on your first attack. With common symptoms like lights, coloured spots, zig zag lines, blindness, nausea, vomiting, weakness and a skull crushing pain- it’s not surprising many rush to the hospital fearing the worst.
How do I know if my headache is a migraine?
The most widely accepted classification amongst the medical community comes from an international body called the International Headache Society (IHS).
The IHS classifies a headache as a migraine when:
(1) The pain has at least two of the following characteristics:
- Moderate to severe pain intensity
- One-sided location in the head
- Pulsating or throbbing quality
- Aggravated by general movement
(2) There is at least one of the following
- Nausea and/or vomiting
- Sensitivity to light and noise
(3) The headache attack lasts 4-72 hours if untreated.
Symptoms that may be experienced during a migraine include:
- Aura – this is a term used to describe the visual disturbances that can occur during migraines. These can include dots, coloured spots, sparkles, stars, flashing lights, tunnel vision, zig zag lines, blind spots and even temporary blindness.
- Sensitivity to light, noise and odours
- Difficulty concentrating, poor articulation, cognitive impairment and confusion
- Stiff neck or shoulders
- Pins and needless, tingling or numbness
- Dizziness or vertigo e.g. feeling like you’re spinning
What happens during a migraine attack?
Our understanding of migraines has improved significantly over the last decade, but there is still a long way to go. Researchers still don’t know exactly what causes a migraine, but the leading theories relate to hyper excitability within certain areas of the brain or a glitch from the brain stem which triggers the migraine.
The brain stem is a small but extremely important part of the brain. It allows the nerve connections of the motor and sensory system to pass from the brain to the body. That covers basically all of our sensations and the ability to move our body. It’s pretty important.
At the start of an attack, chemical changes are thought to develop at the brainstem which trigger a series of reactions causing the brain to react abnormally to otherwise normal signals. The result could be the migraine. Basically, it’s a complicated way of saying migraines are a brain malfunction.
What are the main types of migraine?
There are essentially two basic types of migraine as classified by the IHS. These are:
- A migraine without aura (most common)
- A migraine with aura
Within these two categories are a range of different types of migraines.
A Migraine Without Aura
Often called the ‘common migraine’ these are the most commonly occurring type of migraine. They are often linked with menstruation for women. Sub categories for migraine without aura include ‘Pure Menstrual migraine’ and ‘Menstrually-related migraine’. Migraine without aura is most likely to accelerate with frequent use of symptomatic medication which can result in a new headache called ‘Medication-Overuse Headache’. Very frequent migraine attacks are labeled ‘Chronic Migraine’ provided that there is no medication overuse.
A Migraine With Aura
This type of migraine is often called the ‘classic migraine’. Within this type of migraine are a number of different subtypes of migraine which are listed below:
a) Typical aura with migraine headache – visual disturbance with a migraine headache.
b) Typical aura with non-migraine headache – visual disturbance occurs without a migraine headache. Headache is experienced that does not fulfill the migraine criteria.
c) Typical aura without headache – visual disturbance of the aura, but no headache occurs.
d) Familial hemiplegic migraine (FHM) – This is a migraine with aura that includes motor weakness. Let’s translate this medical speak. ‘Hemiplegic’ relates to the symptoms of motor weakness which is essentially the same thing as your muscles being temporarily weak. Symptoms can resemble a stroke and may progress until one side of body feels paralysed for a few hours. Migraineurs may confuse weakness with numbness, but they are not the same. ‘Familial’ refers to the fact that a 1st or 2nd degree family relative is also diagnosed with migraine aura including motor weakness. Symptoms of FHM may include slurred speech, difficulty talking or weak muscles.
e) Sporadic hemiplegic migraine– if no family relative has been diagnosed or identified with FHM, then you may be classified with Sporadic Hemiplegic migraine. This is the same as FHM, except without the family connection.
f) Basilar-type migraine– this is a migraine with aura that, according to the IHS, has symptoms which clearly originate from the brainstem, but no motor weakness. In these migraines the aura symptoms have at least 2 of the following:
- difficulty articulating speech
- vertigo/ dizziness
- ringing or buzzing in the ears
- hearing impairment
- double vision
- the loss of full control of bodily movements
- reduced level of awareness and alertness
- an abnormal sensation, typically tingling or pricking (‘pins and needles’), caused chiefly by pressure on or damage to peripheral nerves.
As a general rule of thumb:
- if you get the aura with a migraine headache
- don’t experience motor weaknesses
- but you get pins and needles,
then you have a basilar-type migraine.
Other less common types of migraine
a) Retinal migraine – repeated attacks of visual disturbance in one eye, including light flashes, sparkles, partial loss of vision, blind spots or blindness related to migraine headache.
b) Abdominal Migraine – Usually occurring in children, this describes a recurring abdominal pain which may last between 1 to 72 hours. Symptoms include a loss of appetite, nausea and vomiting.
c) Complications of migraine
I. Chronic migraine – when a migraine goes on for 15 days or more per month for over 3 months in the absence of medication overuse. Most chronic cases of migraine start as a migraine without aura.
II. Status migrainosus – a painful migraine attack that lasts for more than 72 hours. Sleep and medication may not be effective in these attacks.
III. Persistent aura without infarction– ‘infarctions’ are the death of an organ or tissue caused by an obstruction of the blood supply. This type of aura occurs when symptoms persist for more than 1 week without radiographic evidence of infarction.
IV. Migrainous infarction– when an inadequate blood supply occurs for too long it may cause a lesion or damage to an organ or tissue. This can be demonstrated by neuroimaging.
V. Migraine-triggered seizure – an epileptic seizure triggered by a migraine aura.
Is it possible to have a migraine that overlaps across one or more migraine types?
Yes. According to the IHS, patients with FHM have basilar-type symptoms in 60% of cases. Doctors are advised by IHS to code the migraine to the FHM in these cases. And only code the migraine to the basiliar-type migraine when there is no motor weakness experienced.
What are the main stages of a migraine?
There are 5 main stages of a migraine.
1) Early Warning Symptom (Prodrome) – This describes the certain physical and mental changes that can precede a migraine attack. Changes such as excessive yawning, stiff neck, feeling thirsty, changes in appetite, drowsiness and mood changes. There is a wide range of changes that can occur which stem from the hypothalamus, the deep-seated part of the brain which affects the regulation of several bodily systems which can affect mood, gut, mind, behaviour and muscular and fluids. They can last from 1 to 24 hours.
Most migraineurs suffer migraines on a recurring basis, which makes it important to understand what your early warning signs are to either avoid the migraine entirely or effectively intervene with treatment. The next time you experience an attack note how you felt or what happened before it to help minimise migraines or avoid it in the future.
2) Aura– Typically lasts from 5 to 60 minutes and is characterized by visual disturbances such as flashing lights or sensory symptoms like pins and needles.
3) Headache – This is when the migraine headache is experienced which lasts between 4- 72 hours. The pain is often on one side of the head and throbbing. The most common symptoms are sensitivity to light, sound, nausea and vomiting.
4) Resolution – The end of the attack. The way in which migraines end varies significantly. Many may be gradual whilst some may be resolved suddenly, for example, being sick can help children feel better quickly. Sleep is restorative for many. Some medications can offer relief. For others, little is effective except letting the migraine run its course.
5) Recovery (Postdrome) – After a migraine attack, migraineurs may feel drained for up to 24 hours, others may energetic or on top of the world.
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- International Headache Society ICHD – II: Diagnostic criteria for Migraine.
- Professor James Lance, Migraine and Other Headaches 2000.
- L Kelman, The Postdrome of the Acute Migraine Attack. Cephalalgia, Feb 2006
- Rasmussen BK, Olesen J. Migraine with Aura and Migraine without Aura: An Epidemiological Study. Cephalalgia, Aug 1992
- Bartleson JD, Cutrer FM. Migraine Update. Diagnosis and Treatment Minnesota Medicine, May 2010.
- Dodick DW, Gargus JJ. Why Migraines Strike. Scientific Amercian. Aug 2008.
- Akerman,S Holland PR, Goadsby PJ. Diencephalic and Brainstem mechanism in migraine. Nature reviews. Nuroscience. Sept 2011.
- Migraine Trust, UK