What are the types of migraines?
Migraine without aura
Recurrent headache disorder manifested as attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, increased by routine physical activity and association with nausea and/or sensitivity to light and sound.
Migraine with aura
Recurrent attacks, lasting minutes, of unilateral fully reversible visual, sensory or other central nervous system symptoms that usually develop gradually, and are usually followed by headache
Aura symptoms include:
Visual: This is a common type of aura. It can be experienced as flashes of light It often manifests as a fortification spectrum: a zigzag figure near the point of fixation, sometimes colored, or dark/grey spots in the field of vision.
Sensory: In the form of pins and needles that travel slowly from its origin and affect a part of one side of the body, face and/or tongue. Numbness may occur in its wake, but it is possible that numbness may also be the only symptom.
Speech and/or language: Difficult to speak coherently, find the right word and in understanding what is spoken to.
Motor: Difficulty if lifting the arm or moving the leg or drooping of the face.
Brainstem: Slurred speech, feeling that the environment is rotating, buzzing or ringing in the ears, double vision, imbalance while walking.
What is Chronic Migraine?
Headache occurring on 15 or more days/month for more than 3 months, which, on at least 8 days/month, has the features of migraine headache.
What are the complications of migraines?
Status migrainosus: Migraine attack lasting for more than 72 hours.
Persistent aura without infarction: Aura symptoms persisting for one week or more without evidence of stroke on brain scans.
Migrainous infarction: One or more migraine aura symptoms occurring in association with the reduced blood supply in a territory of the brain, demonstrated by brain scans, with onset during the course of typical migraine with aura attack.
Migraine aura-triggered seizure: A seizure triggered by an attack of migraine with aura.
What are the episodic conditions that may be associated with migraines?
Cyclical vomiting syndrome: Recurrent episodic bouts of intense nausea and vomiting, which are typically stereotyped in the person and occur at predictable times. Attacks may be associated with pale appearance and lethargy. Between attacks, all signs vanish entirely.
Abdominal migraine: A disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with nausea and vomiting, lasting 2-72 hours and with normality between episodes. During these episodes, there are no headaches. Adults may also have abdominal migraines with dyspepsia and abdominal pain.
Benign paroxysmal vertigo: In otherwise healthy children, a condition marked by repeated brief attacks of dizziness that arise without warning and resolve spontaneously.
Trigeminal autonomic cephalalgias (TACs)
What is a Cluster headache?
Extreme, one-sided pain in eyes, above the eyes, temple, or some mixture of these locations that lasts from 15 minutes to 3 hours and happens once every other day to eight times a day. On the same side of the headache there is often associated redness of the eye, watering from the eye, nasal stuffiness or watery nose, forehead and facial sweating, pupil becoming smaller, droopy eyelid, and/or eyelid puffiness, as well as with restlessness or agitation.
It can be:
Episodic: Cluster headache attacks occur in periods lasting from 7 days to one year, separated by pain-free periods lasting at least 3 months.
Chronic: Cluster headache attacks occurring for one year or longer without remission, or with remission periods lasting less than 3 months.
What is Paroxysmal hemicrania?
One-sided headache that lasts 2-30 minutes and occurs several times a day. They may be associated with redness of the eye, watering from the eye, nasal stuffiness or a watery nose. They respond remarkably to Indomethacin tablets.
It can be:
Episodic: Attacks of paroxysmal hemicrania occurring in periods lasting from 7 days to one year, separated by pain-free periods lasting at least 3 months.
Chronic: Attacks of paroxysmal hemicrania occurring for more than one year without remission, or with remission periods lasting less than 3 months.
What is Hemicrania continua?
Persistent, strictly one-sided headache of more than 3 months duration that may be associated with redness of the eye, watering from the eye, nasal stuffiness or watery nose. They respond remarkably to Indomethacin tablets.
It can be:
Remitting subtype: Hemicrania continua characterized by pain that is not continuous but is interrupted by remission periods of at least 24 hours’ duration.
Unremitting subtype: Hemicrania continua characterized by continuous pain for at least one year, without remission periods of at least 24 hours.
What are Short-lasting unilateral neuralgiform headaches?
Attacks of moderate or severe, purely unilateral head pain lasting seconds to minutes, occurring at least once a day and usually associated with prominent lacrimation and redness of the ipsilateral eye.
It can be:
- Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT): if associated with redness of the eye and tearing one the side of pain.
- Short-lasting unilateral neuralgiform headache attacks with cranial autonomic symptoms (SUNA): the redness and tearing may not be prominent symptoms and only one of them may be present.
Episodic: Attacks of Short-lasting unilateral neuralgiform headache attacks occurring in periods lasting from 7 days to one year, separated by pain-free periods lasting 3 months or more.
Chronic: Attacks of Short-lasting unilateral neuralgiform headache attacks occurring in periods lasting from more than one year without remission, or with remission periods lasting less than 3 months.
IMPORTANT POINT: All the following primary headaches can also be a manifestation of secondary headaches
Dr. Pravin Thomas | Consultant & Clinical Lead – Headache & Interventional Headache Neurology Services | Mazumdar Shaw Medical Center, Bommasandra, Bangalore