Types of migraine

Abdominal migraine

Abdominal migraine is one of the variants of migraine. It is also known as "periodic syndrome". Occurring in around 4% of children, the predominant symptom of the attack is abdominal pain rather than a headache. Sometimes it can be misdiagnosed in an A&E as appendicitis.

They usually have a family history of migraine and go on to develop typical migraine later in their life.

The attacks are characterised by periodic bouts of moderate to severe midline abdominal pain lasting for 1 to 72 hours. Along with the abdominal pain they may have other symptoms such as nausea and vomiting, flushing or pallor.

Medications that are useful for treating migraine work to control these attacks in most children including daily preventive medications and anti-nausea medications to take during the attack.


Acephalgic migraine

Also called silent migraine, migraine aura without headache, amigrainous migraine, isolated visual migraine and optical migraine.
It is a neurological syndrome.

It is a rare variant of migraine in which the patient may experience aura, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache.


Basilar artery migraine

Also known as Bickerstaff's Migraine. This is a rare form of migraine with aura, it is where the basilar artery (a blood vessel at the base of the brain) goes into spasm causing a reduced blood supply to parts of the brain.

This type of migraine affects 1 in every 400 migraineurs. It comes on suddenly and can result in fleeting visual disturbances, giddiness, confusion, lack of balance, double vision, unsteadiness, fainting, tingling on both sides of the body and even loss of consciousness. The aura typically lasts less than one hour.

Often these patients are mistakenly thought to be intoxicated, under the influence of drugs, or suffering from other conditions. There is usually no weakness associated with these attacks. The headache that follows is typical of migraine headache.

The basilar artery migraine is strongly related to hormonal influences and primarily strikes young adult women and adolescent girls; as sufferers age, the migraine with aura may replace the basilar artery type.


Classical migraine

This is migraine with aura. This is when you get neurological disturbances lasting between 15 minutes and an hour, before you get an actual headache.

A third of people have aura with their migraine.

Common aura symptoms include:

• visual disturbances – such as flashing or flickering lights, zigzag lines, blurred vision, temporary blindness
• numbness or a tingling sensation – common in the hands, arm or face, similar to ‘pins and needles’
• slurred speech
• poor concentration
• problems with your co-ordination


Common migraine

This is a migraine with no aura. It is typical a headache affecting one half of the head and pulsating in nature and lasting from 4 to 72 hours; symptoms include:

• nausea and/or vomiting
• Increased sensitivity to light
• Increased sensitivity to sound
• Increased sensitivity to smell


Chronic Migraine

Migraine can evolve from episodic headaches to a chronic pain syndrome. Chronic migraine is defined as a migraine headache occurring on 15 or more days per month for more than three months of which 8 are migrainous and in the absence of medication


Hemiplegic migraine

This is a very rare form of migraine that is considered to be one of the more severe types of migraine It has been linked to a genetic abnormality and it is being more readily diagnosed by the medical profession in the UK. Symptoms include temporary paralysis down one side of the body, which can last for several days.

It can be accompanied by other symptoms, such as ataxia, coma, epileptic seizures, vertigo or difficulty walking, double vision or blindness, hearing impairment, numbness around the mouth leading to trouble speaking or swallowing. These symptoms are often associated with a severe one-sided headache.

This form of migraine may be confused with a stroke, but the effects are usually fully reversible.

There are two types of hemiplegic migraine:

1. Familial hemiplegic migraine is where migraine attacks occur in two or more people in the same family and every individual experiences weakness on one side of the body as a symptom with their migraine. In about 50% of these families, a chromosome defect may be found on chromosome 19 or on chromosome 1 and involves abnormal calcium channels.

2. Sporadic hemiplegic migraine is where someone experiences all the physical symptoms of familial hemiplegic migraine but doesn't have a known connection within their family. The cause of this type of hemiplegic migraine is unknown; some are due to new or so called 'sporadic' gene mutations.

You should not take triptans if you have this type of headache.


Hormonal migraine

Female migraineurs tend to be more susceptible to an attack around the time of their period and menstrual migraine is defined as occurring within two days either side of the first day of a period and at no other time.

Hormonal factors are one of many triggers for migraine and attacks may be prevented if other triggers are avoided around the time of their period for female migraineurs


Ice Pick Migraine

These migraines are characterised by quick stabs of piercing head pain. The pain occurs intermittently in several locations in the head area. They usually occur between one of the more common migraine attacks. They can last for seconds or a few minutes

Migraine in children

Migraine in children may be similar to adult presentations and include headache, with or without aura, accompanied by nausea, vomiting, photophobia, and relief with sleep. However, several variations of migraine are unique to children and rarely if ever occur in adults. Migraine may present with prominent nonheadache symptoms in young children (migraine without headache), or neurologic symptoms (aura) may be much more prominent than the headache.

Various recognized childhood syndromes assumed to be pathophysiologically related to migraine include benign paroxysmal vertigo of childhood, abdominal migraine, cyclic vomiting of childhood, and acute confusional migraine (acute confusional state). Basilar migraine (particularly in adolescent girls) may present with prominent dizziness and near-syncope and/or syncope with or without a subsequent headache. Hemiplegic migraine (usually an autosomal dominant disorder) may present in early childhood and occasionally may continue into adulthood. Ophthalmoplegic migraine also may occur in childhood.


Nocturnal Migraine

Many patients who have migraine will experience their attacks during the middle of the night or early morning hours. This headache often awakens the patient from sleep. Recent evidence suggests that these attacks are related to changes in neurotransmitters in the brain during sleep.


Ocular / opthalmoplegic migraine

This is another rare form of migraine with pain often experienced around the eye, causing droopiness, redness of the eye and excessive watering. It can last from a few days to a few months. It can be accompanied by nausea, vomiting and double vision.

There may be paralysis in the muscles surrounding the eye. If these symptoms occur, you should seek immediate medical attention because the symptoms can be caused by pressure on the nerves behind the eye.


Retinal migraine

Another rare migraine, the retinal type starts with a temporary, partial, or complete loss of vision in one eye. It is followed by a dull ache behind that eye that may spread to the rest of the head.

During some episodes, the visual loss may occur with no headache and at other times throbbing headache on the same side of the head as the visual loss may occur, accompanied by severe light sensitivity and/or nausea. After each episode, normal vision returns.

Retinal migraine is a different disease than scintillating scotoma, which is a visual anomaly caused by spreading depression in the occipital cortex, at the back of the brain, not in the eyes nor any component thereof, such as the retinas. Such a scintillating aura affects both eyes, and sufferers may see flashes of light; zigzagging patterns; blind spots; and shimmering spots or stars. In contrast, retinal migraine involves repeated bouts of temporary diminished vision or blindness in one eye.