MIGRAINE AND ITS TYPES

Migraine headache ranks in the top 20 of the world’s most disabling conditions affecting people of all races and ages1. Being a debilitating condition, the amount of absenteeism from work and school is very high. This is also attributed to the fact that migraine is one of the world’s highly under-diagnosed conditions. Since most people confuse migraine headache with a sinus or general headache, the complexity of migraine headache gets often neglected.

Migraine headaches are characterised by a throbbing or pulsating pain on one side of the head coupled with feelings of sickness such as nausea and vomiting. In some cases sensory disturbances such as sensitivity to light, sound and smell is also reported. When doctors say that Migraine is a complex disorder, they really mean it, because there are several types of migraine headaches. By understanding each type of migraine and knowing which one affects you the most, will be helpful for you and your doctor to draw up the treatment course.

What are different types of Migraines?

Common Migraine: This is the highly prevalent type of migraine, also known as migraine without aura. It is estimated that almost 11% of general population in the world suffer from common migraine2. According to doctors, this type of migraine is worsened with overuse of over-the-counter headache pills. Hence if you suffer from common migraine, then consult a doctor for appropriate medication rather than blindly popping pills. In most cases, relief from headache is achieved post vomiting. A common migraine headache can last for anywhere between 4 hours to 72 hours. If the headache continues for over 72 hours then it is known as status migrainosus, which requires immediate medical attention.3

Symptoms of common migraine406

  • Throbbing headache on one side of the head
  • Aversion to light, sound and smell
  • Fatigue
  • Nausea and vomiting
  • Irritability and mood changes
  • Inability to focus on work
  • Worsening condition with movement

Classic Migraine: This type is also known as Migraine with Aura. People suffering from aura experience dazzling flash of light, hazy spots or zigzag lines in their vision few minutes prior to the commencement of the migraine attack. Around 15-20% migraineurs have aura symptoms5. Sometimes, classic migraine aura can also occur without the throbbing headache which is known as acephalgic migraine5.

Symptoms of classic migraine5

  • Flashing lights or hazy spots in vision
  • Numbness or tingling sensation
  • Difficulty in speaking and confusion
  • Smelling a strange odour or ringing in ears
  • Nausea and loss of appetite
  • In extreme cases complete or partial loss of vision

Menstrual Migraine: Migraine is a condition that is 2 times more common in women than men.6Many women have reported a strong connection between their menstrual date and onset of migraine attack. Here the main trigger for migraine is the fluctuating hormones during periods. The fall in the levels of estrogen is thought to trigger migraine headache6. In a menstrual migraine, the onset of attack can be 2 days prior to periods or 2 days after periods begin. Most women complain migraine during their periods and this is observed month after month. There are two types of patterns observed. 6

  • Pure migraine: in this type migraine headache occurs only around periods and not other times.
  • Menstrual-associated migraine: here migraine attack occurs around the time of periods or anytime during the cycle. Around 60% of women complain of this type of migraine.

Chronic Migraine: This is a severe form of Migraine. A headache that occurs for more than 15 days in a month for 3 months is defined as chronic migraine4. Over the course of time the headache continues throughout the day with occasional migraine symptoms such as nausea and vomiting. Due to the complexity of nature of this type of migraine, this headache is difficult to treat. Avoiding triggers and behavioural modification, along with stress management and a good diet may help in a long way to control chronic migraine. This is one of the most disabling forms of migraine.

Migraine Without headache or Acephalgic Migraine: Also known as typical aura without headache, this type manifests all symptoms of a classic migraine, but without the headache5. Here the patient experiences visual disturbances such as flashing lights and hazy spots as seen in a migraine with aura. Sometimes, fever, dizziness, chills and pain in other parts of body too may be observed.

Abdominal Migraine7: In this type, the migraineur experiences light to severe abdominal pain along with nausea and vomiting during the attack. This is commonly seen in children who have a history of migraine in their family. Unfortunately, these children may suffer from Classic migraine in their adult life.

The above mentioned were some of the commonly examined types of migraine in clinical practice. Below are some of the rare types of migraine.

Familial Hemiplegic Migraine: This is a very rare and an inherited condition. Here the sufferer experiences weakness or paralysis on one side of the body sometimes lasting for day’s together prior to the commencement of headache or during headache.

Symptoms of Familial Hemiplegic Migraine 8:

  • Paralysis on one side of the body
  • Vertigo
  • Pricking or stabbing sensation
  • Disturbance in vision and speech
  • Other symptoms that is similar to a stroke

Basilar Artery Migraine9: This type usually affects children and young adults and is characterised by a headache that is originated at the brain stem. Hence, patients experience ache around the back of the head.

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Symptoms of Basilar Artery Migraine:

  • Sudden or throbbing pain on one side of the head or both
  • Partial or total loss of vision
  • Vomiting
  • Dizziness, loss of balance and fainting
  • Speech disturbance
  • Decreased muscle coordination
  • Ringing in ears

Retinal Migraine or Occular Migraine10: This involves a temporary, partial or total loss of vision in one eye lasting couple of hours that may or may not always be accompanied by a headache.

Ophthalmoplegic Migraine:11 This is a type of migraine that requires immediate medical attention as patients develop a partial or complete paralysis in the nerves that control movement of the eye.

 Is Migraine a threatening disorder?

As frightening as Migraine may sound, the good news is that with proper care and medication, migraine can be treated. Observing the headache patterns and maintaining a headache/migraine diary can help you and your doctor to accurately judge the type of migraine and then chalk out a treatment option for complete relief from migraine.

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Refs:

1 http://www.migrainetrust.org/

2 J Headache Pain. 2015; 16: 50.

3 Brazilian Journal of Anesthesiology Volume 65, Issue 5, September–October 2015

4 Toxins (Basel). 2015 Jul; 7(7): 2615–2628.

5 J Med Case Rep. 2015; 9: 40.

6 Tidsskr Nor Legeforen 2008; 128: 2575-8

7 J PediatrNeurosci. 2015 Jan-Mar; 10(1): 13–17.

8 Case Rep Neurol. 2015 Jan-Apr; 7(1): 84–89.

9 http://ihs-classification.org/en/02_klassifikation/02_teil1/01.02.06_migraine.html

10 http://www.nhs.uk/conditions/retinal-migraine/Pages/Introduction.aspx

11  J Headache Pain. 2014; 15(1): 19.