4 different types of migraine headache

Being aware about different types of migraine headaches and identifying the specific type can be helpful in ultimately getting the right treatment. 

The primary concern of every person with migraine is how can they stop or reduce the intensity of the pain. But there are many complications involved with the disease; these complications make gaining migraine-related knowledge crucial. 

What are the different types of headaches? What type of headache is a migraine? 

There are 150+ types of headaches; following are the most common types of headaches: 

• Tension-induced headaches 

• Migraine headaches 

• Cluster headaches 

• Sinus headaches 

Headaches are classified into two categories, primary and secondary, based on their causes. When a headache isn’t caused by a separate medical condition, it is known as primary headache (e.g., migraine). Whereas, a secondary headache, such as sinus headache or medication overuse headache, is a symptom of a health problem, which generally is different from the headache. 

Migraine, characterised by throbbing pain on one side of the head, can intensify if proper treatment is not given. In comparison with migraine, other headaches (such as tension-induced headache) are less severe. 

Most types of migraines (discussed later) are debilitating for people and can even stop them from going about their lives. People with migraine experience steady throbbing pain, which can last anywhere from 4 to 72 hours or more. 

It is true that tension-induced headaches and migraines can be triggered by stress and fatigue, but there are other triggers for migraine as well. To identify whether you have a migraine or a different type of headache, notice if you have any common symptoms of migraine: 

• Pulsating pain (moderate-to-severe in intensity) 

• Nausea 

• Sensitivity to sensory stimulation (light, sound, or smell) 

Different types of headaches, especially migraine, respond differently to the same treatment. For example, drugs used to relieve tension-induced headaches do not work for migraine headaches. 

People often confuse migraine with sinus headache because of common symptoms such as pressure and pain in the sinuses, watery eyes, and nasal congestion. Sinus headaches will go away only after the infected sinus is cured; however, migraines may subside automatically after a few hours. 

What are phases of migraine? How long do they last? 

Migraine is a neurological disorder that occurs in four different stages, each with a distinct symptom and timeline. However, it is important to note that everyone may not go through all of the phases. 

One person can go through all stages in approximately 72 hours, while another may have to suspend work for a few days during a migraine attack. 

First phase—prodrome/pre-headache 

Usually stretching over a few hours, prodrome (also known as pre-monitory) may sometimes go on for a few days. People may experience changes in their energy levels and appetite along with the following symptoms in this stage: 

• Neck stiffness 
• Constipation 
• Increased urination 
• Frequent yawning 
• Sudden mood swings 
• Food cravings 
• Neck stiffness 
• Water retention 

Second phase—aura 

Aura can be defined as a warning signal that builds up gradually and may last for anywhere between 5 minutes and an hour. Approximately one in every four people experience this phase. An aura, which usually starts before the headache, may affect a person during the headache phase. 

The symptoms of an aura (usually consisting of visual disturbances) are as follows: 

• Blind spots or temporary blindness 

• Seeing light flashes 

• Seeing coloured lines or spots 

• Dizziness and weakness 

• Difficulty in communication (e.g., slurry speech) 

• Numbness or tingling sensation in different parts of the body 

• Temporary paralysis in hemiplegic migraine 

The symptoms of an aura can be frightening sometimes, but all nervous-system-related symptoms are reversible, and no permanent damage has been reported yet. However, if left unchecked, chronic migraine might lead to strokes in some individuals. 

Besides, some people who have migraines with aura may experience symptoms of an aura but not the headache itself (silent migraines). 

Third phase—headache 

Migraines are well-known for pulsating or throbbing pain they cause on either side of the head. This pain lasts for 4–72 hours. Most people report the migraine headache of moderate to severe intensity. People should prefer to rest at home during this phase as they might not be able to work anyhow. 

Following are the symptoms of the third or headache phase of migraine: 

• A constant throbbing pain in one side of the head 

• Nausea and vomiting 

• Sensitivity towards sensory stimulation including light, sound, and occasionally smell or even touch 

Depending on the person, migraines may occur once or twice a year or strike 2 to 3 times a week. 

Fourth phase—postdrome 

Also known as the resolution stage, postdrome may last for a few days. This stage feels like a hangover because of the subsiding symptoms of migraine. A person may feel drained, unable to concentrate, or even elated during this period.

Sudden head movements might cause a brief pain. Prodrome can also last up to two days after the headache stops. 

What are the different types of migraines? 

Migraine is a complex neurological condition that can be classified into the following categories: 

• Migraine with aura 

Approximately 25% of people with migraine experience an aura (a warning phase) before or during the headache. An aura can last anywhere from 5 to 60 minutes. A person who has migraine with aura can experience symptoms, such as seeing flashing lights and coloured spots/patterns, or momentary blindness. 

Some people have also been reported to feel confused or disoriented or to experience slurry speech. Although it is rare for the people who have migraines with aura to faint, it can happen due to overall poor health. 

The risk of stroke is slightly higher in people who have migraine with aura than in those who have migraine without aura. Migraine with aura can be divided further into the following subtypes: 

• Migraine with brainstem aura 

Previously known as ‘basilar-type migraine’, migraine with brainstem aura may be followed by a headache that is presented at the back of the head (brainstem translates to the base of the brain). This type of migraine may be seen in people who develop migraine gradually over time. 

Following are the common symptoms of migraine with brainstem aura: 

• Tinnitus or ringing in the ears 

• Double or blurry vision 

• Vertigo 

• Slurred speech (dysarthria) 

• Disorientation 

• Dizziness 

• Confusion 

• Syncope or temporary decrease in consciousness 

• Sensation of numbness and/or pins and needles in limbs 

The first occurrence of symptoms associated with migraine with brainstem aura is usually observed in adulthood. This condition usually requires medical diagnosis. People experiencing similar symptoms should go for a general-physician consultation, where the doctor might investigate your case further. It is crucial to rule out the possibility of other diseases (such as epilepsy, ischaemic stroke, Ménière’s disease, or vestibular disorders) to receive appropriate treatment. 

• Hemiplegic migraine 

This is a rare condition which causes temporary paralysis (hemiplegia) during the aura phase in one side of the body. A headache onslaught is uncertain in this type of migraine. Following symptoms can be observed when a person has hemiplegic migraine: 

• Dizziness or confusion 

• Ringing in the ears or hearing problems 

• Speech difficulties (inability to speak properly) 

• Temporary weakness and/or tingling session in one side of the body 

• Visual disturbances (seeing coloured spots or sparkles) 

• Difficulty in written and verbal communication (problems with listening, speaking, reading, and writing) 

The symptoms of hemiplegic migraine are similar to those of stroke and can be worrisome. However, going for a general-physician consultation can reveal that the symptoms are reversible. The postdrome period usually lasts for 24 hours with a lingering sensation of weakness. 

Hemiplegic migraine can also be of two types. 

Familial hemiplegic migraine (FHM): It is a form of migraine that runs in a family lineage. Gene (including CACNA1A, ATP1A2, and SCN1A) mutations are known to affect the working of calcium channels in nerve cells in the people with this condition. The people of the same family are likely to experience symptoms such as weakness on one side of the body. There is around 50% chance of a child being affected by FHM if one of their parents has the condition. 

Sporadic hemiplegic migraine (SHM): When a person has all the symptoms of hemiplegic migraine, but the person does not have a known family member with the condition, they are diagnosed with SHM. Sporadic or new gene mutation could probably be the cause behind this condition. Most people with this condition have aura symptoms for a few hours or a day, but they can last longer. 

1. Retinal migraine 

Retinal migraine, also known as ocular migraine, is known to cause partial or complete loss of vision in one eye that usually lasts for 10–20 minutes. People often report a dull ache behind the affected eye; this ache can sometimes spread throughout the head. Usually, the same eye is affected and goes back to normal after the migraine attack. It is important to report a retinal migraine every time as it may be a symptom of another underlying disease, which may cause permanent damage to the eye. 

A small risk of damage to the retina due to decreased blood flow is associated with this type of migraine. Although, permanent vision loss due to retinal migraine is rare. The frequency of retinal migraine attacks may vary; in severe cases people get retinal migraine attacks every month. Smoking, excessive heat, dehydration, high blood pressure, and low blood sugar among others, are some common triggers of retinal migraine. 

• Migraine without aura 

People affected with this type of migraine do not get any warning about the approaching migraine attack; that is, they do not experience an aura. Migraine without aura was formerly known as ‘common migraine’ as it is indeed the most common type of migraine that affects individuals for 4–72 hours. 

This type of migraine has limited symptoms: 

• Throbbing or pulsating pain on one side of the head 
• Nausea and/or vomiting
• Increased sensitivity to light and sound 

Any physical activity during the attack can intensify the symptoms of migraine without aura; hence, people are recommended to rest in a quite dark room. Lifestyle changes can reduce the frequency of these attacks. Preventive treatment in the form of medication such as beta-blockers or acute treatment in the form of over-the-counter pain relievers may be administered to the affected individual. 

• Status migrainosus 

As a rare type of migraine, status migrainosus features severe symptoms that can continue for more than 72 hours. This type of migraine is associated with excruciating pain and nausea; the symptoms are so bad that people may also require a hospital visit sometimes. Changes in a person’s medication or weather, stress, and/or certain medication can be the triggers of status migrainosus. 

• Migraine without head pain 

In migraine without head pain, formerly known as ‘acephalgic migraine’, people go through a migraine attack without any headache. Migraine without head pain is also commonly referred to as ‘silent migraine’. 

• Chronic migraine 

When a person with migraine experiences the symptoms of migraine for at least 15 days in a month, the condition is classified as chronic migraine. This is a debilitating condition that gravely impacts the life of around 2 in every 100 people. Depending on the person’s lifestyle or the treatment given, the symptoms of chronic migraine may change in frequency and severity. 

Research has shown that two out of every three individuals with chronic migraine experience medication overdue headaches. If the frequency of migraine attacks has suddenly increased, it is a good idea to go for a basic full body check-up; a doctor may advice neurological examination to accurately diagnose chronic migraine.  

It is important to note that the same type of migraine may go by various names and that everyone may not fit into these aforementioned categories exactly. 

What are rebound/medicine-induced migraines? 

Also known as medication overuse headache (MOH), rebound migraine headaches are caused by the frequent use of pain relievers for acute treatment. 

People who have a headache on 15 or more days in a month and take pain relievers quite often for about 3 months are likely to get rebound headache or MOH. In such a scenario, the body does not respond well to these medicines, and instead, pain relievers become the very cause of headaches. 

Generally, the treatment for rebound migraines involves stopping pain relievers and changing the treatment method or reducing the dosage slowly over time. 

How are different types of migraine headaches diagnosed? 

Diagnosing migraine is quite complex as little is known about the cause and cure about the disease. Migraine with less severe symptoms is often undiagnosed as people may casually shrug it off as a minor headache and may not realise that they have a neurological disorder. 

Additionally, sometimes people experience symptoms similar to a sinus headache as mentioned above. In such cases, the only tell-tell signs are the frequency of episodic migraines and how they respond to the treatment given. 

If a person complains about headache regularly, they should go for a general-physician consultation. Even if they have been diagnosed with migraine earlier, it is best to consult a doctor again in case there is a change in symptoms to prevent any complications. Chronic migraine or migraine with brainstem aura are known to gradually develop over time in people who have migraine. 

The likelihood of a person having migraine (of a particular type) increases if someone in their family has the condition, especially if it is one of their parents. 

Tracking symptoms 

The treatment administered to one person with migraine is likely to be different from the treatment given to another; this is because different people have different symptoms and triggers. To give right treatment to an individual, their doctor might ask them to keep a track of their symptoms and potential triggers in a ‘migraine journal’. 

This journal should include every little detail about the migraine attack, from what have they been eating to how is the weather during each attack. People often make notes about such things in their phone, instead of a journal. Depending on the data collected, the doctor may diagnose the type of migraine and share an appropriate prescription for treating the condition. 

Since migraine is diagnosed clinically based on the symptoms described by a person, tracking details about every migraine attack can be highly effective in preventing any complications later on. 

Tests to confirm 

As of yet, there is no definitive test to confirm that a person has migraine other than a thorough diagnosis of a person’s symptoms and medical history by a trained general physician. However, a doctor may suggest people who have severe types of migraine (such as hemiplegic migraine or status migrainosus) to go for a basic full body check-up. 

Depending on the severity of the symptoms or other factors the doctor might also request imaging tests (such as a CT scan or MRI) to rule out possibilities of other diseases. An electroencephalogram (EEG) can be recommended to eliminate any chances of seizures. 

When should I seek medical attention? 

Not everyone goes running to a doctor at the slightest sign of discomfort, and most people prefer self-medicating for common ailments like cough and cold, mild fever, and nausea. However, with migraine, doing so can be a little complicated due to the nature of the disease. It is recommended that a person should seek medical attention for following scenarios: 

• When experiencing symptoms for the first time 

It can be confusing for a person when migraine attacks for the first time—pulsating pain in one side of the head, which may or may not be accompanied by aura symptoms. Going for a general-physician consultation to address any strange occurrence in one’s body is a healthy habit that promotes longevity. 

• When things go out of hand 

A person with migraine should go to an emergency room for immediate medical attention if they observe any of the following signs: 

• Visual problems (such as partial or complete loss of sight in one eye) 

• A sudden headache of severe intensity 

• Numbness or weakness in any body part 

• Stiff neck and/or confusion 

• Fever with other symptoms of migraine 

• New headache that started after the age of 50 

• Headache that started after a recent head injury 

• Increase in the intensity of severe headache with an increased physical activity 

• For routine visits 

Basic full body check-ups and a general physician consultation may seem like a hassle at a moment, but they can prevent the further advancement of migraine headaches in a person or even prevent complications. 

• When any new change occurs in the headache pattern that seems severe 

As mentioned earlier, the serious types of migraine develop in people over time due to several reasons (mostly unknown). Thus, people who have migraine should consult their doctor or a specialist whenever there is a change in the headache pattern and when the condition seems to be getting worse. 

• When prescribed medicine doesn’t work 

It is not uncommon in people with migraine to notice that a particular medicine stops working after some time. Instead of keeping up with the same prescription, it is best to consult the doctor and share the new discovery to prevent medicine-overuse headaches. 

Migraine—triggers and frequency 

People may have different migraine triggers; tracking symptoms and other factors around a migraine attack can help to identify these triggers. Following is a list of common triggers of migraine: 

Physical triggers: 

• Over exertion 

• Lack or excess sleep 

• Poor quality sleep 

• Bad posture 

• Jet lag 

• Low blood sugar levels (hypoglycaemia) 

• Tension in the shoulders or neck 

• Hormonal changes (such as during menstruation) 

Emotional triggers: 

• Stress 

• Shock or excitement 

• Anxiety 

• Depression 

Dietary triggers: 

• Skipping meals 

• Dehydration  

• Irregular meal timings 

• Alcohol 

• Certain food additives and preservatives 

• Caffeine 

• Cheese and/or processed foods 

Environmental triggers: 

• Stuffy atmosphere 

• Bright lights 

• Loud noises 

• Smoking (active or passive) 

• Flickering screens (television or computers) 

• Sudden changes in weather 

• Pungent smells 

The frequency of migraine attacks can vary from once a year to few times a week. However, this frequency is likely to change from time to time, with some cases developing into chronic migraine and people have migraine symptoms for about 15 days or more in a month. 

Treatment for migraine 

What treatment is appropriate for an individual is determined by their doctor on the basis of various factors—type of migraine along with frequency, duration, and severity of the symptoms. 

All in all, there are majorly two approaches to treating migraine: 

1. Acute or abortive treatment, which deals with stopping severe pain or minimising its intensity. Pain-relieving medication is given to individuals who are going through a migraine attack in this approach. 
2. Preventive treatment, which aims at delaying or preventing future migraine attacks. This form of treatment works wonders for people who have frequent and long-lasting migraines or have frightening neurological symptoms during their attacks (such as temporary paralysis). 

Medicine for treating migraine 

Below mentioned drugs are a few examples of medication given to people with migraine on a doctor’s prescription. 

Pain relievers: Over-the-counter pain relievers such as ibuprofen or aspirin can help in reducing the pain. Overusing these medicines may lead to medication-overuse headaches, gastrointestinal bleeding, or ulcers. 

Triptans: Prescription drugs that block pain receptors, such as rizatriptan and sumatriptan, are used to treat different types of migraine pain. 

Dihydroergotamine: An effective drug when taken right after the first symptoms surface, dihydroergotamine works best for migraine attacks that go on for more than 24 hours. It is important to note that this prescription drug is not suitable for every individual. 

CGRP antagonists: This is a potent prescription drug that can reduce the symptoms of nausea, pain, and sensitivity to sound and light in approximately 2 hours. 

Opioid medications: People who are not responding to other forms of medicine or treatment are prescribed these drugs as last resort because these drugs are highly addictive. 

Anti-nausea drugs: People are advised to pair pain relievers with drugs (like chlorpromazine) to reduce the severe symptoms of nausea and vomiting. 

Drugs that reduce blood pressure: Beta blockers, including propranolol and metoprolol tartrate, are prescribed to treat migraine without aura, whereas calcium channel blockers (like verapamil) are given to those who have migraine with aura. 

CGRP monoclonal antibodies: Doctors might suggest the use of drugs (including galcanezumab-gnlm, eptinezumab-jjmr, and fremanezumab-vfrm) once a month or once every 3 months intravenously.  

Home remedies 

Stress is a common migraine trigger that can be eliminated (or managed at the very least) by regularly practising yoga and meditation. In addition to decreasing the frequency and intensity of migraine attacks, these practices also improve overall health and well-being of a person.  

Besides, following home remedies have proven to be beneficial to people who have migraine in improving their symptoms during a migraine attack: 

• Rest in a dark, quiet room and try to sleep 

• Take deep breaths to maintain calmness 

• Get a scalp massage or apply pressure to the temples 

• Drink plenty of water 

• Apply a cold compress to back of the neck and forehead 

Alternative therapies 

In addition to (or instead of) conventional treatments for migraine, there are alternative or complimentary treatment options available to people nowadays. Consult a doctor before beginning any alternative method of treatment for migraine. 

• Biofeedback 

A relatively new method of mind-body therapy, biofeedback assists people in manoeuvring subtle commands to their body and changing the course of a full-blown (potentially) attack at will after practice. 

• Cognitive behavioural therapy (CBT) 

A specialist will help people with migraine who opt for CBT in developing coping mechanisms to deal with migraine better. People learn to change their own thinking, problematic emotions, and behaviour in this psychological therapy. 

• Body work 

Physical treatments such as acupressure, acupuncture, chiropractic, massages, and craniosacral therapies might help some individuals with their migraine headaches and other symptoms. 

Are there any specialists for migraine? 

Since migraine is a neurological disorder, the best person to approach for advice is likely a neurologist. However, people often go for a general-physician consultation on noticing few symptoms of migraine. After assessing the situation, the doctor may direct a person to consult a neurologist if the case is complex. 

Takeaway

Even if the migraine you have does not fit perfectly into any type of migraine, the best way to manage the condition is by taking preventive measures. Migraine, sixth most debilitating disease in the world, can be stressful, especially for people who are chasing their dream careers. 

Going for regular visits to the doctor and maintaining a healthy and balanced lifestyle can reduce the intensity of migraine attacks over the long haul.