
Debilitating Headache? It May Be One of These 9 Types of Migraines
Migraine is a complex neurological disorder known for causing severe headaches. People with migraine headaches may experience nausea and sensitivity to light or sound. These episodes are known as migraine attacks.
Migraine affects up to 12% of the global population and is the second leading cause of disability worldwide.
There are several types of migraine headaches. Knowing the type of migraine can help you predict and manage your symptoms.
Migraine without aura involves migraine symptoms without a change in vision, sensation, or speech. It’s the most common type, affecting up to 75% of people with migraine. You may be more likely to have it if a parent also has migraines.
Experts believe that the cause of these migraines is activation of the trigeminal nerve. This nerve is one of your cranial nerves. It transmits pain signals in your head and face.
Migraines without aura typically evolve through three phases: the premonitory phase, headache phase, and postdrome phase. Each causes different symptoms. Overall, these migraine attacks last 4-72 hours.
Recognizing the symptoms of each phase in a migraine attack can help you treat your attack earlier and more effectively. Medication typically works better if taken at the first sign of an attack.
Symptoms by Phase
The premonitory phase is the first stage of a migraine, occurring before the headache begins. The premonitory phase may cause:
- Yawning
- Mood changes
- Neck stiffness
- Fatigue
- Increased thirst
- Difficulty concentrating
The headache phase is when you experience an active headache along with other symptoms. This phase may cause:
- One-sided, pulsing head pain that worsens with head movements
- Moderate to severe pain, typically over the temple or eye
- Sensitivity to light, sounds, or smells
- Nausea
- Vomiting
- Eye redness or tearing
- Allodynia (nerve pain without a cause)
The postdrome phase (or “migraine hangover”) occurs after your headache subsides. This phase may cause:
- Drowsiness
- Sensitivity to noise
- Difficulty concentrating
About 25% of people with migraines experience an aura, a temporary, reversible change in their senses. Most auras (about 90%) affect vision but may also affect sensation or speech. Auras are likely caused by a slow wave of electrical changes moving across the brain. This cascade of electrical current is called cortical spreading depression.
If a family member has auras, you’re more likely to experience them. Auras typically last 5-60 minutes. They usually appear before a migraine headache begins, but some people experience them at the same time as their headache.
Symptoms
Aura symptoms spread slowly rather than appearing all at once. In addition to the symptoms that occur in migraine without aura, symptoms of migraine with aura may include:
- Vision changes: These may include blurriness, dark spots, shimmering lights, zig-zag lines, or colorful shapes in your vision.
- Sensory changes: You may feel tingly or numb in your body, face, or fingers.
- Speech changes: You may slur your speech or struggle to find words.
Vestibular migraine makes up 25% of headaches seen in clinics. Researchers aren’t sure what causes this type of migraine but believe it has to do with problems in the inner ear’s structure.
Most people with vestibular migraine are female. You’re also more likely to experience this type of migraine if you’re younger than 40, experience anxiety or depression, or have a history of head trauma.
Vestibular migraine attacks last five minutes to 72 hours.
Symptoms
Vestibular migraine may cause symptoms such as:
- One-sided, severe, pulsing head pain
- Sensitivity to light and sound
- Visual changes
- Vertigo
- Motion sickness
- Dizziness
- Nausea
Symptoms typically become worse with head movements.
Menstrual migraines are similar to migraines with or without aura, but they happen around menstruation.
People typically experience them two days before their period and up to three days into their period. Researchers think that changes in estrogen levels around this time may directly trigger neurotransmitters (brain chemicals) in the brain that could be related to migraine.
Symptoms
Menstrual migraine may cause:
- Pulsing, one-sided head pain that lasts about a day
- Nausea
- Sensitivity to light
- Pain with light touch (such as putting in contact lenses, shaving, or hair brushing)
About 1% of the global population experiences chronic migraine, meaning they experience headaches at least 15 days per month. To be diagnosed with chronic migraine, migraine-level headaches need to occur at least eight of those days for at least three months in a row.
Symptoms
Chronic headaches may cause all the symptoms of migraine with or without aura, but they occur more frequently. You may also experience changes to your bowel movements, such as diarrhea.
Abdominal migraine causes intense stomach pain, usually along with headaches. It’s a type of migraine that’s more common in children than adults. One study found that 9% of children had abdominal migraines, and most had family members with other types of migraine. Most people with this condition don’t experience symptoms as adults.
Experts don’t yet know what causes abdominal migraines. Unlike other types of migraines, abdominal migraine symptoms don’t appear to have strong triggers.
Symptoms
The main feature of abdominal migraines is severe stomach pain that lasts more than one hour. Along with stomach pain, abdominal migraines may cause symptoms such as:
- Headache
- Loss of appetite
- Pale skin
- Nausea
- Vomiting
- Sensitivity to light
- Unexplained pain in the arms or legs
Migraine aura without headache is sometimes called a silent migraine. This rare type of migraine affects 3% of women and 1% of men. You’re more likely to experience this type of migraine if you’re older or have a history of migraine with aura.
Researchers aren’t sure why migraines with aura happen without head pain, but they believe it’s caused by the same cortical spreading depression wave that triggers other auras.
Symptoms
As the name suggests, migraine aura without headache may cause migraine symptoms without the classic headache. An attack won’t have any pulsing head pain. Instead, you may notice an aura that comes on slowly and disappears within 60 minutes.
These migraines may also cause:
- Dizziness
- Numbness
- Temporary changes to memory
- Difficulty speaking
It’s possible for your symptoms to change slightly from one attack to another.
Hemiplegic migraine is another rare form of migraine, affecting 0.01% of the general population. It causes one-sided weakness as a motor (movement) aura. Most people experience their first hemiplegic migraine attack at 12-17 years old. Like most migraines, it’s more common in girls and women.
Hemiplegic migraine has a strong genetic connection and has been linked to specific genes. You’re more likely to experience this type of migraine if someone in your family has them. Common triggers include head trauma, physical or emotional stress, and too much or too little sleep.
Symptoms
The hallmark symptom of hemiplegic migraine is one-sided muscle weakness, but other auras may also be present. Symptoms—which may resemble a stroke—usually last for several hours or days. In rare cases, symptoms can last up to a month.
Weakness typically starts in your hand and moves up your arm and toward your face. Muscle weakness may switch from one side of the body to the other but is rarely felt on both sides at the same time.
People with hemiplegic migraines may also experience:
- Headache
- Visual, sensory, or speech auras
- Fever
- Fatigue
- Clumsy movement
Retinal migraines cause temporary vision loss along with the migraine headache. It’s a very rare type of migraine and may be slightly more common in women than in men.
Retinal migraines typically begin in your 20s and peak in your 40s. You’re more likely to have this type of migraine if someone in your family experiences them. Retinal migraines may be triggered by high blood pressure, bending over, low blood sugar, or dehydration.
Symptoms
People with retinal migraine may experience the same pulsing, one-sided headache symptoms of other migraine types. They usually experience visual auras, too. Retinal migraines also cause:
- Temporary blindness
- A flickering spot of light
- A blind spot
If you have migraine symptoms, it’s important to see a neurologist (a doctor who treats the brain and nervous system). They can usually make a migraine diagnosis with clinical examination and a discussion of your symptoms. Your provider can also tell you which type of migraine you have.
It helps to go prepared with information about your symptoms. The neurologist may ask about the type of head pain and other symptoms you may have. If you experience an aura, they may want details about what that experience is like for you. They’ll likely ask about the frequency of your attacks to diagnose or rule out chronic or menstrual migraine patterns, too.
In some cases, your healthcare provider may suggest additional testing, like imaging procedures, to rule out other conditions such as stroke. They may need to rule out an eye disorder before diagnosing retinal migraine or silent migraine, which might require a visit to the eye doctor for a full evaluation. You may also need bloodwork and neurological testing to rule out other disorders.
It’s important to see a healthcare provider if you’re experiencing undiagnosed migraine symptoms or if your diagnosed migraine symptoms aren’t well managed. Your neurologist can recommend treatments for migraine to help manage your symptoms, both during an attack and to help prevent future ones.
For managing a current migraine, your neurologist may recommend medications such as:
- Triptans
- Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen or acetaminophen
- Gepants
- Antinausea medication
For preventing your next migraine, your neurologist may recommend medications such as:
- Beta-blockers
- Calcium channel blockers
- Topamax (topiramate)
- Elavil (amitriptyline)
Severe hemiplegic migraine attacks can cause serious complications. If you’re experiencing one-sided paralysis and impaired awareness, seek help immediately. While rare, a severe hemiplegic migraine attack can cause permanent brain injury and death if left untreated.
Up to 76% of people with migraines may have an identifiable trigger that contributes to their migraine attacks. You may be able to prevent a migraine by avoiding triggers when possible. Some common triggers include:
- Stress
- Emotional intensity
- Physical exertion or exercise
- Changes to your sleep
- Bright lights
- Head trauma
The most common types of migraine headaches are migraine with or without aura, but there are other types.
Chronic migraines occur when a person experiences 15 or more headache days a month—with at least eight migraines.
A visit to a neurologist can help you determine which type of migraine you may have.