Migraine attacks are really painful, debilitating headaches that affect all sufferers the same way, right? Sorta. Yes, they're painful and debilitating, but no, they’re not all the same.
In fact, it’s normal for sufferers to experience totally different symptoms, depending on their personal triggers and patterns. Plus, there are several different types of migraine to begin with.
So how do you know which type you’re dealing with—or if it’s even migraine at all? Doctors break down migraine into several categories, and learning more about which type you might have can help you get a diagnosis and a personalized treatment that works for you.
Let’s take a look at the types of migraine, starting with the most common.
1. Migraine without aura
Main symptoms: throbbing pain that starts on one side of your head (for many sufferers, it tends to start behind the left eye), moving around tends to make the pain worse, and it’s normal to feel nauseous, dizzy, and sensitive to light and sound
Duration: 4–72 hours
The first and most widespread type of migraine is known as the common migraine. It, like other headaches formally recognized by doctors, is listed in the International Classification of Headache Disorders (ICHD-3).
But even within this category, there’s some nuance. Ready for a few numbers? Here goes:
If, for at least three months in a row, you get a headache more than 15 times per month, and eight of them have migraine symptoms, that means your migraine might be becoming chronic. Chronic migraine attacks will typically have the same symptoms as episodic migraine that just pops up now and then.
When you get a common migraine, you might also notice that you feel strange in the hours or days before the actual headache sets in. This is called the “prodrome,” which is medical lingo for the first phase of a migraine attack. The prodrome can bring on:
- difficulty speaking or reading
- increased urination
- irritability and depression
- food cravings
- frequent yawning
- muscle fatigue or tight or stiff muscles, particularly in the neck and shoulders
- nausea, constipation, or diarrhea
- poor concentration
- sensitivity to light, sound, touch, and smell
- trouble sleeping
As if that’s not enough, after the 4–72-hour headache hits, it’s normal to get a “migraine hangover,” or postdrome. The hangover can make you:
- feel moody
- feel sensitive to touch, especially in the areas where your headache was focused
- feel tired
- have stomach issues
Here’s some more info about how the common migraine progresses.
2. Migraine with aura
Main symptoms: visual disturbances before an attack begins, followed by common migraine symptoms
Duration: can range from a few minutes to a full hour, usually before the migraine attack itself starts (the attack itself can last from 4–72 hours)
About 25% of people who suffer from migraine also experience aura. Migraine with aura is a broad category listed in the ICHD-3, and can cause visual disturbances and neurological symptoms, as well as unpleasant feelings like a numb face or tongue, and pins and needles that spread across your body.
The ICHD-3 break these down even further into four types:
Typical aura can bring on visual symptoms, such as temporary blind spots, geometric patterns, zigzag lines, stars or shimmering spots, and flashes of light.
Brainstem aura involves symptoms that seem to originate in the brainstem, like difficulty speaking, double vision, ringing ears, or vertigo.
Hemiplegic migraine involves symptoms like motor weakness or a loss of muscle strength, usually on one side of your body, and according to Genetics Home Reference, you could struggle with language and feel confused or tired.
Like with typical attacks with aura, these symptoms usually last just minutes and no more than an hour (though for some people it can be longer). However, memory loss and problems with your attention span can linger for weeks or even months. Sometimes, hemiplegic migraine can cause more serious issues, like seizures, coma, and long-term problems with brain function and body movement. These might be frightening facts to read, so know that this type of migraine is rare and the extreme side effects are uncommon.
Retinal or ocular migraine
Retinal migraine (a.k.a. ocular migraine and optical migraine) differs from a typical migraine with aura in that you only have visual disturbances in one eye. Because it causes visual issues, it's sometimes called “ocular migraine” or “optical migraine.”
3. Menstrual Migraine
Main symptoms: coincides with your period
Duration: 4–72 hours
Menstrual migraine, or “hormonal migraine” is pretty much what it sounds like—migraine attacks in women triggered by hormonal changes. It's listed in the official ICHD-3, which notes that menstrual migraine can happen with aura or without, and usually strikes just before or at the beginning of your period. If you suffer from attacks during this time in two out of three periods, it might be menstrual migraine.
Menstrual migraine attacks may be triggered by the quick drop in estrogen and progesterone that happens before your period starts, and they affect about 7–19% of women. That said, most women with menstrual migraine also have headaches at other times, too.
A frustrating but good-to-know fact from the Journal of Headache and Pain is that menstrual migraine attacks tend to last longer than your average non-menstrual attacks, and might be more painful.
4. Vestibular migraine
Main symptoms: vertigo, dizziness, and trouble with balance
Duration: ranges from a few seconds to a few days
Vestibular migraine can give you sudden bouts of vertigo, where you either feel like you’re moving when you’re not, or see the world spinning. And it's surprisingly common, affecting 30–50% of migraine sufferers.
Sometimes this happens when you move your head, or when you see something particularly stimulating. However, the vertigo attacks might not always occur right before a headache sets in, like aura symptoms. In fact, Cephalalgia notes that they might last for just a few seconds or even for a few days.
5. Migraine without headache
Main Symptoms: no actual headache pain
Duration: each symptom can last 1 hour or less
Now this one might make you do a double-take. If you get aura symptoms but never get the telltale splitting pain in your head, you might have a migraine without a headache, sometimes known as a “silent migraine,” “painless migraine,” or “acephalgic migraine.” The ICHD-3 simply calls them a typical migraine with aura without a headache.
An acelphagic migraine, or a migraine with no pain, can have all the same symptoms of migraine with aura, except the headache never shows up. Interestingly, the American Migraine Foundation notes that migraine attacks without headaches become more likely as you get older.
6. Abdominal Migraine
Main symptom: stomach pain instead of a headache
Duration: 1-72 hours
Yep, you read that right—abdominal. Sometimes, instead of a headache, migraine can cause extreme pain in your abdomen. This is abdominal migraine, and it’s more common in children than adults—though 2/3 of them end up developing migraine headaches as adolescents.
The ICHD-3 lists it as a condition that might be associated with migraine. According to the American Migraine Foundation, abdominal migraine causes pain near the belly button, and can also make you feel nauseous, give you no appetite, cause vomiting, and make you look pale.
Just like common migraine, abdominal migraine can be triggered by things like stress, bright lights, and food additives like monosodium glutamate (MSG). It's also typically treated using the same medications as standard migraine attacks with headaches.
7. Status Migrainosus
Main symptoms: a migraine attack that that lasts more than 72 hours
Duration: 72+ hours
Status migrainosus is basically a migraine attack (with or without aura) that lasts longer than the standard max of 72 hours. The ICHD-3 recognizes status migrainosus, and points out that overusing migraine medications could be a likely cause. However, other triggers can bring them on too, like:
- changes in food and sleep habits
- changes in medication
- changes in weather
- head and neck traumas
- illnesses, like the flu or a sinus infection
- sinus, tooth, or jaw surgeries
Status migrainosus can be extremely frustrating, to put it mildly. The National Headache Foundation calls it a “trick candle on a birthday cake,” because the headache might briefly respond to medication, only to flood back after a break.
What's not migraine
If none of these descriptions seem quite right, it’s possible your headaches might be something besides migraine. Other common types of headaches are:
Tension headaches are the most common headaches for adults. Here are a few key differences that separate them from migraine:
- The pain is typically less severe than in migraine, more of an ache than a throbbing pain.
- They affect both sides of your head.
- They don’t get worse when you’re active.
- They don’t cause symptoms like sensitivity to light and sound or nausea.
Cluster headaches cause extreme head pain, but, unlike migraine, they appear up to eight times per day in bursts (or clusters) of weeks or months and feel more like stabbing pain than throbbing.
Sinus headaches are caused by a sinus infection and are rare. In fact, people often think they have sinus headaches when they actually have migraine.
Post-traumatic headaches happen after a traumatic injury, and can cause symptoms that mimic migraine, like severe throbbing pain that gets worse if you move around, nausea and vomiting, and sensitivity to light and sound. It typically ends within a few months but can become “persistent” and last longer, especially if you have a family history of or already suffer from migraine.
New Daily Persistent Headaches
New daily persistent headaches are what they sound like—headaches that suddenly begin to pop up every day, keeping you in pain for over three months, reports. You’ll need to see a doctor to learn the true cause of NDPH, but it can be treated like a migraine if the symptoms are the same.
If you have painful, recurring headaches, you know one thing: You want them to go away. The first step is finding a doctor to help you figure out just what a kind of headache you’re dealing with. Once you know that, you’ll be better able to figure out the best treatment.
The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.
Photo by Hamish Duncan on Unsplash.