Types Of Migraines: Symptoms, Differences, and How Each Is Treated
Migraine is not one specific illness but a collection of neurological diseases that fall under different subtypes. Each subtype has its own symptoms, triggers, and treatment methods. Under the International Headache Society’s (IHS, 2022) classification system, migraine has several medically recognized types that differ by symptom cluster and duration of attacks. If you suffer from migraine, it is important to know what type you experience to best help diagnose you and treat your headaches. Most migraine types are migraine with aura, migraine without aura, chronic migraine, vestibular migraine, and hemiplegic migraine.
Migraine Without Aura
Migraine without aura is the most frequently occurring migraine subtype. It makes up 75% of migraines according to the World Health Organization. (2023)
Symptoms
* Moderate to severe throbbing headache
* Pain intensifies when walking or doing other physical activity
* Feeling nauseous or vomiting
* Light sensitivity and sound sensitivity
* Pain lasting for 4-72 hours if untreated
Key Facts
- Migraine without aura has no preceding neurological warning symptoms
- Stress, hormonal changes, poor sleep, and dietary factors are the most common triggers
- Migraine without aura is more common in women and often linked to menstrual cycle fluctuations
Migraine With Aura
Migraine with aura affects approximately 25 to 30% of people with migraines and is characterized by temporary neurological symptoms that develop before or during the headache phase.
Symptoms
- Visual disturbances such as zigzag lines, flashing lights, blind spots, or tunnel vision
- Numbness or tingling (pins and needles) on one side of the face, arm, or hand
- Difficulty speaking or finding words (aphasia)
- Muscle weakness on one side of the body in some cases
- Aura symptoms typically develop gradually over 5 to 20 minutes and last no longer than 60 minutes
Key Facts
- Aura symptoms are fully reversible and resolve before or as the headache develops
- Women with migraines with aura face an increased risk of ischemic stroke (a stroke caused by a blood clot), particularly when using estrogen-containing contraceptives, according to the WHO (202Migraine with aura and migraine without aura can occur in the same person at different times
Chronic Migraine
Chronic migraine is defined as migraine occurring 15 or more days per month for more than three months, with at least 8 of those days meeting criteria for migraine, according to the International Headache Society (2022).
Symptoms
- Frequent moderate to severe head pain occurring most days of the month
- Significant impact on daily functioning, work, and relationships
- Often accompanied by anxiety, depression, and sleep disturbances
- Increased sensitivity to light, sound, and smell even between attacks
Key Facts
- Chronic migraine affects around 2% of people.
- Medication overuse headache (MOH), which occurs when pain relievers are taken more than 10 days per month, is a major driver of episodic migraine progressing to chronic migraine
- Preventive treatments including CGRP inhibitors, topiramate, and botulinum toxin (Botox) injections are the primary management options for chronic migraine
Vestibular Migraine
Vestibular migraine is a subtype characterized by episodes of dizziness and balance disturbances, with or without head pain, making vestibular migraine one of the misdiagnosed migraines.
The symptoms include:
* Episodic vertigo (feelings of spinning) that lasts minutes to hours
* Dizziness.
* Motion sensitivity or sensitivity to visual stimulation
* Nausea/vomiting
* Headache can be absent, mild, or post vestibular symptoms
Key Facts
* Vestibular migraine is the leading cause of spontaneous episodic vertigo in adults (Barany Society, 2022)
* Vestibular migraine is often misdiagnosed as Meniere’s disease or benign paroxysmal positional vertigo (BPPV, an inner ear condition).
Triggers are similar to other migraine types and include stress, sleep disruption, hormonal changes, and dietary factors.
Hemiplegic Migraine
Hemiplegic migraine is a rare and severe subtype characterized by temporary one-sided motor weakness or paralysis as part of the aura, which can closely mimic a stroke.
Symptoms
- Temporary weakness or paralysis on one side of the body (hemiplegia)
- Visual aura symptoms including zigzag lines or blind spots
- Speech difficulties and confusion
- Severe headache following motor symptoms
- Symptoms can last from hours to several days in rare cases
Key Facts
- Hemiplegic migraine can be familial (inherited, caused by genetic mutations) or sporadic (occurring without a family history)
- Triptans and ergotamines are generally avoided in hemiplegic migraine due to theoretical vascular risks
- Hemiplegic migraine requires prompt medical evaluation to rule out stroke, particularly during a first episode
Menstrual Migraine
Menstrual migraine is a hormonally triggered subtype occurring specifically around the menstrual cycle due to estrogen fluctuations.
Symptoms
- Migraine attacks occurring in a window of 2 days before to 3 days after the start of menstruation
- Typically occurring without aura.
- Longer duration, greater severity, and reduced response to standard treatments compared to non-menstrual migraines
- Often accompanied by other premenstrual symptoms such as bloating, mood changes, and fatigue
Key Facts
- Menstrual migraines affect around 60% of women with migraines, according to the American Headache Society (2021)
- Mini-prophylaxis using frovatriptan or naproxen sodium around the menstrual window is the most evidence-based preventive approach.
- Menstrual migraine occurs only during menstruation and affects approximately 14 % of women.
Retinal Migraine
Retinal migraine is a rare type that involves temporary loss of vision in one eye only, rather than both eyes, as seen in typical migraine with aura.
Symptoms
- Temporary partial or complete vision loss in one eye
- Flashing lights or blind spots affecting only one eye
- Mild to moderate headache following or accompanying visual symptoms
- Episodes typically last less than 60 minutes.
Key Facts
- Retinal migraine is rare and should always be checked by a clinician to rule out serious eye or vascular conditions
- Repeated retinal migraine attacks may pose a risk of permanent vision damage in rare cases
- Estrogen-containing contraceptives and smoking are recognized risk factors for retinal migraine
Types of Migraines at a Glance
Conclusion
Migraine is a wide range of neurological subtypes, with varied symptoms, triggers and treatment requirements. The most prevalent forms of migraine are migraine without aura and migraine with aura, and other unique clinical manifestations include chronic migraine, vestibular migraine, hemiplegic migraine, menstrual migraine and retinal migraine that can present specific challenges in diagnosis and management.
A precise diagnosis of the specific type of migraine is vital if you’re going to select the very best treatment. Those with new, intense or changing headache patterns should undergo evaluation by a neurologist.
