Maybe you’ve seen flashes of light across your field of vision and you’ve known a migraine was on its way. Or you’ve headed for bed, waiting for one to ease up.
Migraine comes in a variety of different “flavours,” and “tastes” different to each of us. Yes, the base ingredients are the same, but symptoms and severity can vary by person, attack, and over time.
Knowing exactly which type of Migraine you have is essential to finding the most effective treatment.
It’s a fact: 60% of women and 70% of men with Migraine aren’t diagnosed properly. Getting an accurate diagnosis is critical for the right treatment. Some medications are dangerous to people who have Migraine with Aura, for example.
But migraines aren’t alike. Yours might be very different from someone else’s.
Which are the two major types of Migraine? Migraine with Aura (Classic Migraine ), and Migraine without Aura (Common Migraine).
In this article, we are going to focus on migraines with aura and its subtypes.
Migraine with Aura (Classic Migraine)
About a quarter of people who experience migraine also experience an aura, a series of sensory and visual changes that can range from seeing black dots and zig zags to tingling numbness on one side of the body, or an inability to speak clearly. Aura sets in shortly before or during a migraine and can last anywhere from 10 to 30 minutes. Aura is the second of migraine’s four stages, and anyone who experiences it will confirm it is an unmistakable warning sign that the severe head pain is on its way.
Scientists aren't sure what causes migraine, but several brain chemicals probably play a role. (Learn more about what happen to your brain when you have migraine here)
According to one theory, a wave of nerve cell activity spreads across the brain, its like an electrical storm in the brain. This excitation causes the release of a variety of neurotransmitters (brain chemicals) which caused a change in the size of the blood vessel, releasing more neurotransmitters and ultimately causing an inflammatory response and this is then registered as head pain (via the trigeminal nerve)
The aura which about 25% of migraine sufferers experience is believed to be due to this electrical wave moving across the part of your brain that processes signals from your senses.
Migraine often runs in families. They frequently begin in childhood and get worse through adolescence. Although more boys than girls have a migraine, more adult women than men have them. Over time, you'll get fewer, and they tend to become less common after age 50. (Here are 11 interesting facts about migraine)
About a third of people will get warning signs hours or days before a migraine. This is called the prodrome or pre-headache phase. You may:
- Be fatigued and yawn more
- Need to urinate more often
- Have food cravings
- Feel stiff, especially your neck
- Get "hyper" or cranky
- Get constipated or have diarrheas
What is aura?
Aura is a term used to describe a neurological symptom of migraine, most commonly visual disturbances.
People who experience ‘migraine with aura’ will have many or all the symptoms of a “migraine without aura” and additional neurological symptoms which develop over a 5 to 20-minute period and last less than an hour.
Visual disturbances can include:
- flashing lights before the eyes
- tunnel vision
- sparkles or stars
- zig-zag lines
- colored spots
- blind spots in the field of eyesight
- temporary blindness.
Other aura symptoms can include:
- weakness on one side of the body
- pins and needles in the arms and legs
- numbness or tingling
- a feeling of spinning (vertigo).
Speech and hearing can be affected, and some people have reported memory changes, feelings of fear and confusion and, more rarely, partial paralysis or fainting.
These neurological symptoms usually happen before a headache, which could be mild, or no headache may follow.
Likely frequency of attacks
Frequency can vary anywhere from once a year to many times per month.
10-30% of people with migraine experience auras.
Migraine attack stages or phases
It is often difficult to predict when a migraine attack is going to happen. However, you can often predict the pattern of each attack as there are well-defined stages. It is these stages and their symptoms which distinguish a migraine from a headache.
In adults, we can divide a migraine attack into four or five stages that lead on from each other:
- The premonitory or warning phase
- Aura (not always present)
- The headache or main attack stage
- Recovery or postdrome stage
Learning to recognize the different phases of a migraine attack can be useful. You might get one, all, or a combination of these stages, and the combination of stages may vary from attack to attack. Each phase can vary in length and severity.
Recognizing different symptoms at different times during your headache attack can give information to your doctor that may help diagnosis. Also, taking medication before the symptoms have fully developed may reduce the effect of an attack. A child’s migraine attack is often much shorter than an adult’s attack, and it may therefore not be possible to fully make out the different headache phases.
- Premonitory Stage
This describes certain physical and mental changes such as tiredness, craving sweet foods, mood changes, feeling thirsty and a stiff neck. These feelings can last from 1 to 24 hours. Often it is the partners or close family members that notice this is happening to the migraine sufferer.
The aura of migraine includes a wide range of neurological symptoms. This stage can last from 5 to 60 minutes and usually happens before the headache. Migraine without aura does not include this stage.
In some people, changes in the cortex area of the brain cause changes in their sight, such as dark spots, colored spots, sparkles or ‘stars’, and zigzag lines. Numbness or tingling, weakness, and dizziness or vertigo (the feeling of everything spinning) can also happen. Speech and hearing can also be disturbed, and people with migraines have reported memory changes, feelings of fear and confusion, and more rarely, partial paralysis or fainting. These neurological symptoms are called the ‘aura’ of migraine. In adults, they usually happen before the headache itself, but in children, they may happen at the same time as the headache. It is possible to have aura symptoms without the headache.
- The Headache or Main Attack Stage
This stage involves head pain which can be severe, even unbearable. The headache is typically throbbing and made worse by movement. Some people describe a pressing or tightening pain. The headache is usually on one side of the head, especially at the start of an attack. However, it is not uncommon to get pain on both sides, or all over the head. Nausea (sickness) and vomiting (being sick) can happen at this stage, and the person with migraine may feel sensitive to light or sound, or both.
Most attacks slowly fade away, but some stop suddenly after the person with migraine vomits or has an emotional release.
Sleep seems to help many people, who find that even an hour or two can be enough to end an attack. Many children find that sleeping for just a few minutes can stop their attack.
- Recovery or Postdrome Stage
This is the final stage of an attack, and it can take hours or days for a ‘hangover’ type feeling to disappear. Symptoms can be like those of the first stage, and often they are mirrored symptoms. For example, if you lost your appetite at the beginning of the attack, you might be very hungry now. If you were tired, now you might feel full of energy. (Find out more about what you should and shouldn't do when you have migraine)
Your doctor will give you a physical exam and check your muscles, reflexes, speech, and senses to test the nerves in your head. He'll also ask about your health history.
- Do other family members have a migraine or other kinds of headaches?
- What medications do you take, including birth control pills or blood pressure drugs?
- Do your headaches start after working hard, coughing, or sneezing?
Blood tests and imaging, such as X-ray, CT scan, or MRI, can help rule out other causes like an infection and bleeding.
When you're having a migraine with aura, stay in a quiet, darkroom. Try cold compresses or pressure on the painful areas.
Over-the-counter pain relievers like aspirin, acetaminophen, or non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help. Your doctor can prescribe larger doses of NSAIDs. (Do not use aspirin in anyone under the age of 19.)
The prescription medications are called triptans may also be effective in treating migraine pain.
Other medications can ease related symptoms such as nausea and vomiting.
If you don’t respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to reduce the severity or frequency of the headaches. These include seizure medicines, blood pressure medicines (like beta-blockers and calcium channel blockers), and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines don’t help. (Here are some migraine home remedies that might be helpful for you)
Avoid your triggers. Common ones include:
- Being tired, sick, or hungry
- Hormone level changes
- Flickering or flashing light
- Air pressure or altitude changes
A headache diary can help you and your doctor figure out what might be setting off your headaches. Note the date and time of the migraine, any foods you ate, what you were doing, and any medication you took before the headache began. It may take several weeks to begin to see a pattern. (You can learn more about migraine and diet here)
Migraine Without Aura (Common Migraine)
A migraine without aura is more than just a headache. The pain alone is enough to stop you from carrying on your daily activities. And then there's nausea, maybe vomiting, and more.
Diagnosing migraine without aura can be difficult because the symptoms are like several other types of migraines. Pulsing or throbbing pain on one side of the head, phonophobia, pain that is made worse by physical activity, and nausea and vomiting are all classic symptoms of Migraine without Aura. The key differentiator is that Common Migraine lacks the warning phases (prodrome and aura) that other types of migraine have.
What Is It and What Causes It?
A migraine without aura is the most common type of migraine headache. They account for about 75% of all migraines. Another name you might hear is "common migraine." It doesn’t have the early symptoms, called an aura, that some people have before a migraine begins, like vision changes, dizziness, confusion, feeling prickling skin, and weakness.
Scientists aren't sure what causes migraines. They think that many brain chemicals such as– serotonin, calcitonin gene-related peptide, and dopamine -- play a role. According to the theory, a wave of nerve cell activity spreads across the brain and excites the trigeminal nerve. This excitation causes the release of a variety of neurotransmitters which caused a change in the size of the blood vessels releasing more neurotransmitters and ultimately causing an inflammatory process and pain.
Migraines often run in families, so researchers think there may be a genetic link for the condition. Other things can trigger migraine attacks for some people, like some foods, smells, stress, and things in the environment.
Migraines often begin in childhood and get worse through adolescence. Although more boys than girls have migraines, more adult women than adult men have them. But they usually happen less over time. Migraines become rare after age 50.
Although painful, migraine without aura is not life-threatening.
In patients who suffer from headaches or migraines without aura, the pain comes with no warning. This headache condition is generally characterized by three distinct phases but, oddly enough, headache without aura may skip the headache phase. Each stage is described below:
This pre-headache phase often serves as a warning that an attack is coming, and in some cases, the patient can prevent the headache. The prodrome phase occurs hours or even days before a headache attack. Symptoms may include:
- Constipation or diarrhea
- Fatigue and/or yawning
- Food cravings
- Increased frequency of urination
- Mood changes like irritability and depression
- Muscle stiffness, particularly in the neck
Headache pain ranges from mild to intense. This phase is the most debilitating part of the migraine. The entire body, not just the head, is affected. The intense pain most commonly begins at around 6 a.m., and it usually lasts 1 – 72 hours.
Characteristics typically include several of the following:
- Unilateral (one-sided) headache pain, although young children may experience bilateral (two-sided) pain
- Pain that occurs around the eyes, sinuses, and jaw
- Pain that is worsened by physical activity
- Neck pain
- Increased sensitivity to light, sound, and odors
- Dizziness or vertigo
- Nausea and vomiting
- Diarrhea or constipation
- Dehydration or fluid retention
- Hot flashes or chills
- Nasal congestion or runny nose
- Depression, anxiety or confusion
Once the headache phase ends, the attack may or may not be over. The recovery or post-headache phase can last for hours or even days. Sufferers report feeling “zombie-like” or “hungover,” which may be an effect of the medications taken or the headache itself. Symptoms can include:
- Feelings of depression, well-being or euphoria
- Reduced ability to concentrate and lowered comprehension
- Lowered intellect levels
Common symptoms of “migraine without aura”
Most people feel migraine pain in the front of the head, on one or both sides of the temples. It may throb or be steady. The headache may last from 4 to 72 hours.
You might also have any of these other symptoms:
- Feeling "hyper"
- Sensitivity to light, sounds, or motion
- Low blood pressure
- Dark circles under your eyes
- Attacks of ‘migraine without aura’ last between 4 and 72 hours when untreated or unsuccessfully treated.
- The headache is usually on one side of the head with a throbbing or pulsating pain which affects your normal daily life and will worsen when you make exercises such as walking or climbing stairs every day.
- During this type of migraine, you will be likely to feel sick and may vomit or have diarrhea.
- You may also become sensitive to light (photophobia) and/or sound (phonophobia).
How Is It Diagnosed?
Your doctor will want to be sure that there are no other causes for your headache. So, it’s likely he’ll do physical and perhaps neurologic exams. He’ll also ask you about your health history, including questions like:
- What is the level of stress in your life?
- Do you notice that headaches start after coughing or sneezing or after intense exercise?
- Do other people in your family have migraines or other kinds of headaches?
- Do you use medications such as birth control pills or vasodilators that could cause headaches?
- Do you have any allergies?
Your doctor may also use some tests to be sure that your headache isn’t caused by something else:
- Tests for infection, bleeding, or other medical problems that could cause similar symptoms
- Blood tests
- Imaging tests such as X-ray, CT scan, or MRI
What Are the Treatments?
The treatment for migraines without aura has two goals: Relieve your symptoms and prevent future attacks.
To help relieve migraine symptoms:
- Use medications to treat other migraine symptoms such as nausea and vomiting.
- Stay in a quiet, darkroom.
- Take pain-relieving medications such as aspirin, acetaminophen, ibuprofen, ketorolac (Toradol), or naproxen. (Do not use aspirin in anyone under the age of 19)
- Or take prescription drugs
- Or take prescription pain relievers.
- Put cold compresses or use pressure on the painful areas.
To Prevent Migraines Without Aura:
If you don’t respond to other treatments and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to reduce the severity or frequency of the headaches.
Keep a headache diary
It will help you spot anything that might trigger your migraines. Diary entries should include the date and time of your headache, any foods you ate, what you did, and medication you took just before the headache began. It may take 6 to 8 weeks or longer to begin to see patterns and triggers.
Avoid common food triggers
Use information from your diary and from trial and error to figure out if any of these foods might be causing your migraines.
- Red wine or other alcohol
- Citrus fruits
- Artificial sweeteners
- Food preservatives, such as nitrates, nitrites, and monosodium glutamate (MSG)
- Ice cream or other cold foods
Avoid medication triggers
Many over the counter and prescription drugs can bring on migraines.
Never stop taking medicine unless your doctor tells you to.
Relieve mental or emotional triggers
Stress, depression, anxiety, and strong feelings such as grief can trigger migraines. Although you can’t always avoid these things, you can learn to control how you handle them. Relaxation, biofeedback, and self-hypnosis techniques can help relieve these sources of stress and prevent migraines, especially in children.
Reduce physical triggers
Illnesses, missing meals, and being too tired can all trigger migraines. So can overdoing exercise, motion, and head injuries. Even menstruation can set off migraines. To curb the effect of these things, know how they affect you, keep a regular routine, treat illnesses quickly, and take steps to avoid other physical triggers.
Look for environmental triggers
Some people are sensitive to flickering lights, fluorescent lights, changes in air pressure or altitude, or even bold visual patterns. Use your headache diary to spot any possible triggers in your environment and then take steps to get rid of them or avoid them.
If you experience recurrent, long-lasting headaches, you may be suffering from “headache without aura.” This is the most common form of migraine. Because headache sufferers can have more than one type of migraine or migraine plus tension headache, obtaining a professional diagnosis is important.
Likely frequency of attacks
May occur anything from once a year to several times per week.
70-90% of people with migraine experience this type.
There are subtypes of migraines. Here are some:
- Status Migrainous
- Brainstem Aura
- Without head pain
Pinpointing the cause of headache is sometimes complicated. There are many types and many methods of treatment. Focusing on where exactly your head hurts and the accompanying symptoms can help you and your doctor determine what type of migraine or headache you suffer from, resulting in a more effective treatment plan and fewer painful days.