Edited by Eleonora Maria Vladimirou, Well.cy
Migraine is more than just a severe headache. It is a neurological disorder that can take different forms and, in some cases, cause symptoms that affect vision, speech, balance or even movement.
The two main forms are migraine without aura and migraine with aura. There are also less common forms and complications of migraine. Recognizing the symptoms is important because some can resemble those of other, more serious conditions.
Chronic migraine
When headaches become very frequent, they may be a sign of chronic migraine. According to international diagnostic criteria, chronic migraine involves headaches occurring on 15 or more days per month for more than three months, with migraine features on at least some of those days.
The transition from episodic to chronic migraine can happen gradually. That is why it is important to track not only how severe the pain is, but also how often it occurs.
Menstrual migraine
For many women, migraine attacks are closely linked to hormonal changes during the menstrual cycle. The drop in estrogen shortly before a period is considered an important factor in triggering these attacks.
Menstrual migraine may occur only around the time of a period, or it may occur alongside migraine attacks on other days of the month.
Attacks associated with menstruation often last longer, may be more severe and can sometimes be more difficult to treat.
Migraine with brainstem aura
This condition was previously known as "basilar migraine" or "basilar artery migraine." The term migraine with brainstem aura is now used because the condition is not believed to be caused by a problem with the basilar artery.
It is a rare form of migraine that can cause fully reversible neurological symptoms, including:
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vertigo
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tinnitus
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difficulty speaking clearly
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double vision
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problems with balance or coordination
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reduced level of consciousness
These symptoms require medical evaluation, particularly when they occur for the first time.
Hemiplegic migraine
Hemiplegic migraine is a rare form of migraine with aura. Its defining feature is temporary muscle weakness on one side of the body.
Visual disturbances, sensory changes and difficulty speaking can also occur. Because some of these symptoms can resemble those of a stroke, a first or unusual episode requires immediate medical evaluation.
There are two main forms:
Familial hemiplegic migraine (FHM): A first- or second-degree relative has a history of the condition. Specific genetic mutations have also been identified in some families.
Sporadic hemiplegic migraine (SHM): The condition has a similar clinical presentation but occurs without a corresponding family history.
The muscle weakness is usually reversible. In most cases, it lasts less than 72 hours, although it can occasionally persist for longer.
Abdominal migraine
Abdominal migraine occurs mainly in children. Despite the name, headache is not necessarily the main symptom.
The condition is characterized by recurring episodes of abdominal pain, which may be accompanied by:
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nausea
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vomiting
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pale skin
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reduced appetite
Many children with abdominal migraine have a family history of migraine. Some may later develop more typical forms of migraine.
Retinal migraine
Retinal migraine is a very rare form of migraine that causes temporary visual disturbances in one eye. Blind spots or even temporary vision loss may occur.
It should not be confused with the typical visual aura associated with migraine. Sudden vision loss in one eye can also be caused by other conditions, so it requires medical evaluation and should not automatically be attributed to migraine.
Status migrainosus: When an attack lasts more than 72 hours
Status migrainosus is a particularly debilitating complication of migraine. It refers to a migraine attack that lasts for more than 72 hours.
Prolonged pain, nausea and vomiting can lead to significant exhaustion or dehydration. In some cases, medical treatment or even hospitalization may be necessary, especially when a person cannot keep fluids down or their usual treatment is not working.
Is there a "more serious" type of migraine?
There is no single type of migraine that can be considered the most severe for everyone. The severity of an attack depends on its duration, intensity, associated symptoms, frequency and the extent to which it affects a person's daily life.
Some forms, however, such as hemiplegic migraine or status migrainosus, may require emergency or hospital treatment.
What can look like migraine?
Not every severe headache is a migraine. Tension headaches, medication-overuse headaches and various other conditions can cause similar symptoms.
Some neurological symptoms associated with migraine aura can also resemble those of a stroke or transient ischemic attack. Because of this, any sudden or significant change in the way a person's migraine normally presents should be evaluated by a doctor.
When does a headache require immediate medical attention?
Particular attention is needed when a headache is sudden and extremely severe, or when it feels completely different from previous headaches.
Immediate medical attention is also needed if a headache is accompanied by symptoms such as:
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weakness or numbness on one side of the body
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difficulty speaking or understanding speech
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loss of vision or a significant change in vision
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confusion or loss of consciousness
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seizures
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double vision
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fever and a stiff neck
These symptoms should not automatically be attributed to migraine, even in someone who has a history of the condition.
A migraine diary can help
Keeping a record of migraine attacks can be very useful. Write down when the attack started, how long it lasted, which symptoms occurred, how severe they were, what medication was taken and whether there were any possible triggers.
A migraine diary can help a doctor identify patterns and develop an appropriate treatment plan.
Migraine can take many different forms. The important thing is to understand your usual pattern and not ignore a new, unusual or significantly more severe symptom.
Sources
International Headache Society, International Classification of Headache Disorders (ICHD-3)
American Migraine Foundation, What Type of Headache Do You Have?
American Migraine Foundation, What Is Status Migrainosus?
American Migraine Foundation, Menstrual Migraine and Hormones: Understanding the Connection
