Exploring and Understanding the Types of Migraine

A Migraine attack is a Migraine attack, is a Migraine attack, right? Wrong. There are several types of Migraine and even some subtypes of those. It’s important to know which type or types of Migraine we have because which treatments are appropriate and which symptoms, if any, are reason to get medical care can differ according to which type of Migraine we have.

When medical conditions have different types or forms, it’s important that there be accepted, standardized criteria for diagnosing and classification. It’s important for several reasons:

Standardized diagnostic and classification criteria avoids the all-out confusion that would ensue if everyone used different terms and various people meant different things when they discussed a particular form of Migraine. We often see that kind of confusion now when people who don’t conform to the standardized criteria talk about ocular, optical, ophthalmic, or eye Migraines.

For Migraine and other headache disorders, the gold standard for diagnosis and classification is the International Headache Society’s International Classification of Headache Disorders (ICHD), now in its third edition (ICHD-3). The ICHD-3 recognizes the following types and subtypes of Migraine:

1.1 Migraine without aura
“Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.”

1.2 Migraine with aura
“Recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or other central nervous system symptoms that usually develop gradually and are usually followed by headache and associated Migraine symptoms.”

1.2.1 Migraine with typical aura
“Migraine with aura in which aura consists of visual and/or sensory and/or speech/language symptoms, but no motor weakness, and is characterized by gradual development, duration of each symptom no longer than 1 hour, a mix of positive and negative features and complete reversibility.”

1.2.1.1 Typical aura with headache
“Migraine with typical aura in which aura is accompanied or followed within 60 minutes by headache with or without Migraine characteristics.”

1.2.1.2 Typical aura without headache
“Migraine with typical aura in which aura is neither accompanied nor followed by headache of any sort.”

1.2.2 Migraine with brainstem aura
“Migraine with aura symptoms clearly originating from the brainstem, but no motor weakness.”

1.2.3 Hemiplegic Migraine
“Migraine with aura including motor weakness.”

1.2.3.1 Familial hemiplegic Migraine (FHM)
“Migraine with aura including motor weakness, and at least one first- or second-degree relative has Migraine aura including motor weakness.”

1.2.3.1.1 Familial hemiplegic Migraine type 1
Form of FHM determined by specific genetic loci

1.2.3.1.2 Familial hemiplegic Migraine type 2
Form of FHM determined by specific genetic loci

1.2.3.1.3 Familial hemiplegic Migraine type 3
Form of FHM determined by specific genetic loci

1.2.3.1.4 Familial hemiplegic Migraine, other loci
Form of FHM determined by specific genetic loci

1.2.3.2 Sporadic hemiplegic Migraine
“Migraine with aura including motor weakness, and no first- or second-degree relative has Migraine aura including motor weakness.”

1.2.4 Retinal Migraine
“Repeated attacks of monocular visual disturbance, including scintillations, scotomata or blindness, associated with Migraine headache.”

1.3 Chronic Migraine
“Headache occurring on 15 or more days per month for more than 3 months, which has the features of Migraine headache on at least 8 days per month.”

1.4 Complications of Migraine
“Code separately for both the Migraine subtype and for the complication.”

1.4.1 Status migrainosus
“A debilitating Migraine attack lasting for more than 72 hours.”

1.4.2 Persistent aura without infarction
“Aura symptoms persisting for 1 week or more without
evidence of infarction on neuroimaging.”

1.4.3 Migrainous infarction
“One or more Migraine aura symptoms associated with an ischaemic brain lesion in the appropriate territory demonstrated by neuroimaging.”

1.4.4 Migraine aura-triggered seizure
“A seizure triggered by an attack of Migraine with aura.”

1.5 Probable Migraine

1.5.1 Probable Migraine without aura

1.5.2 Probable Migraine with aura

1.6 Episodic syndromes that may be associated with Migraine

1.6.1 Recurrent gastrointestinal disturbance
“Recurrent episodic attacks of abdominal pain and/or discomfort, nausea and/or vomiting, occurring infrequently, chronically or at predictable intervals, that may be associated with Migraine.”

1.6.1.1 Cyclical vomiting syndrome
“Recurrent episodic attacks of intense nausea and vomiting, usually stereotypical in the individual and with predictable timing of episodes. Attacks may be associated with pallor and lethargy. There is complete resolution of symptoms between attacks.”

1.6.1.2 Abdominal Migraine
“An idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms, nausea and vomiting, lasting 2–72 hours and with normality between episodes. Headache does not occur during these episodes.”

1.6.2 Benign paroxysmal vertigo
“A disorder characterized by recurrent brief attacks of vertigo, occurring without warning and resolving spontaneously, in otherwise healthy children.”

1.6.3 Benign paroxysmal torticollis
“Recurrent episodes of head tilt to one side, perhaps with slight rotation, which remit spontaneously. The condition occurs in infants and small children, with onset in the first year.”

A1.6.5 Vestibular Migraine

A diagnosis of “Migraine” is an incomplete diagnosis. A complete diagnosis includes the type or types of Migraine we have, and it’s not unusual to have more than one type. People who have Migraine with aura, seldom have an aura with every Migraine attack, so most people who are diagnosed with Migraine with aura are also diagnosed with Migraine without aura. Chronic Migraine is also an incomplete diagnosis. Here too, a complete diagnosis includes the type or types of Migraine.

Copyright Disclaimer:This article has been RSS syndicated and was originally published here.