Some migraines cause sufferers to see flashing lights. Others cause nausea, or temporary weakness on one side of your body. Some are triggered by changes in the weather, and some by hormonal changes.
Ever wonder why your migraines are different from someone else’s? In reality, the word migraine is used to describe a range of related disorders, each with a different spectrum of symptoms.
International Headache Society Migraine Classification
The International Headache Society has developed a classification system for migraine and headache, the ICHD-3, which has been widely adapted, including by the World Health Organization. In this system, migraine types are classified and named based on the different symptoms associated with each. This system helps doctors with the diagnosis and treatment of headache and migraine disorders. A migraine can be classified into one of the following categories:
- Migraine without Aura
- Migraine with Aura
- Migraine with Typical Aura
- Migraine with Brainstem Aura
- Hemiplegic Migraine
- Retinal Migraine
- Migraine with Typical Aura
- Chronic Migraine
With or Without Aura?
The two most common types of migraine fall into two categories: migraine without aura and migraine with aura.
70-90% of people with migraine experience this type, with attacks lasting between 4 to 72 hours when not successfully treated. Attacks are irregular – they may occur several times a week, or just once a year.
Common symptoms include:
- A throbbing or pulsating pain on one side of the head
- Pain worsens when doing even everyday activities, like walking or climbing stairs
- Nausea, or vomiting
- May become sensitive to light (photophobia) and/or sounds (phonophobia)
The term aura describes the neurological disturbances that can accompany a migraine. It happens to about 1 in 4 people affected by migraines, and each individual symptom during an aura may last 5-60 minutes. Aura usually occurs before the headache, but it may begin after the headache phase has started, or continue into the headache phase. It’s often a sign of an impending attack, although it is possible to experience an aura without an associated headache.
If you have a migraine with aura, you may experience all the symptoms of migraine without aura, plus these additional symptoms:
- Visual symptoms like seeing wavy lines, shapes, dots or flashes
- Blurry vision or blind spots
- Temporary loss of vision
- Tingling or numbness in your arms and legs
- Weakness on one side of the body
- Changes to your sense of smell, taste or touch
Aura can occur anywhere from once a year to several times a week. Aside from migraine with typical aura, there are other sub-types under the Migraine with aura category.
Additional Subtypes Under Migraine with Aura
Subtypes include brainstem aura, hemiplegic aura and retinal migraine.
Migraine with Brainstem Aura
This involves symptoms of the migraine aura such as visual, sensory and/or speech or language symptoms and at least 2 of the following additional symptoms:
- Slurred speech
- Vertigo (a sensation of spinning or dizziness)
- Tinnitus (ringing in the ears)
- Partial or total loss of hearing
- Double vision
- Unsteadiness or loss of balance
The word hemiplegic means paralysis on one side of the body, however most attacks under this subtype are characterized by temporary motor weakness on one side of the body. In this rare type of migraine, symptoms may last from one hour to several days, but usually go away within 24 hours. This can be a frightening experience as the symptoms can seem similar to a stroke.
Symptoms associated with hemiplegic migraines may last for several days
There are 2 types of hemiplegic migraine: familial, which runs in families, and sporadic (occurs randomly). If you experience any of these symptoms, or suspect you may suffer from hemiplegic migraine, see your doctor for more information and a treatment plan.
This form of aura migraine is very rare. It involves visual disturbances, however unlike other migraines that may affect both eyes, retinal migraine affects only one eye. Most often it occurs on the same side as the migraine headache.
The reversible visual symptoms may be as short as a few seconds, but normally last several minutes to an hour, and may be followed by a typical migraine headache. In rare cases, the visual loss in one eye can last hours, days and even weeks.
Retinal Migraines only affect one eye
Disturbances to one eye include:
- Flashing lights, zigzag patterns, coloured streaks, halos and diagonal lines
- Vision losses such as blurring, blind spots, black dots, or partial or complete blindness
- Tunnel vision (loss of peripheral vision)
Because loss of vision in one eye isn’t always related to migraine and may be caused by some other underlying serious condition, it’s important to see your doctor right away for treatment.
The term ocular migraine is often used to describe retinal migraine or sometimes even migraine with aura, and some doctors still use this term, though it is not recognized in the ICHD-3 classification system.
This is a headache that happens 15 or more days a month for more than 3 months. It includes migraine symptoms on at least 8 of those days each month.
Chronic Migraine symptoms
Chronic Migraine symptoms are the same as episodic migraine symptoms, however symptoms occur 15 or more days a month for more than three months. During an attack, you may feel:
- Pain on one side of your head, but often on both sides
- Pain that throbs or pulsates
- Sensitivity to light, sound, and sometimes smell and touch
- Nausea and vomiting
There are some well-recognized risk factors that can lead to Chronic Migraine, including depression, anxiety, obesity, asthma, stressful life events, too much caffeine, and persistent nausea. Talk to your doctor to inquire more about potential risk factors and available treatments.
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Reviewed by Stephen D. Silberstein, MD on August 09, 2017
- “More than ‘Just a Headache.’” The Migraine Trust, The Migraine Trust, www.migrainetrust.org/about-migraine/migraine-what-is-it/more-than-just-a-headache/.
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Medically reviewed by Elaine K. Luo, MD on October 19, 2016
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- Jerry W. Swanson, M.D. “Vision Changes with Headache: When to Seek Help.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 10 May 2019, www.mayoclinic.org/diseases-conditions/migraine-headache/expert-answers/ocular-migraine/faq-20058113.
- “Ocular Migraine | Types of Migraine.” Ocular Migraine | Types of Migraine, Migrane.com, www.migraine.com/migraine-types/ocular-migraine/.
- Erwin, Lisa. “Retinal Migraine.” Migraine.com, Migrane.com, www.migraine.com/migraine-types/retinal-migraine/.
- “Headache Classification Committee of the International Headache Society (HIS) The International Classification of Headache Disorders, 3rd edition.” (2018). Cephalalgia, 38(1), 1–211. https://doi.org/10.1177/0333
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