Fact Sheets

Migraine - What is it?

This fact sheet is intended as a general introduction to the most common types of migraine experienced by adults.

What is migraine?

Migraine is a complex condition with a wide variety of symptoms. For many people the main feature is a painful headache. Other symptoms include disturbed vision, sensitivity to light, sound and smells, feeling sick and vomiting. Migraines can be very frightening and may result in you having to lie still for several hours.

The symptoms will vary from person to person and individuals may have different symptoms during different attacks. Your attacks may differ in length and frequency. Migraines usually last from 4 to 72 hours and most people are free from symptoms between attacks. Migraines can have an enormous impact on your work, family and social lives.

Are there different types of migraine?

There are different types of migraine. In 1988 the International Headache Society produced a classification system for migraine which has been adopted by the World Health Organisation. This has been updated in January 2004 and is the established basis for defining types of headaches. At the end of this fact sheet you will find charts that summarise the different types of migraine as classified by the International Headache Society.

Headache or migraine?

Distinguishing between different types of headache can be difficult. You can experience different types of headaches at different times of your life for varying reasons. For example, if you have migraine you may also experience other types of headache. Keeping a migraine or headache diary is really useful and can be invaluable in trying to identify a specific headache type.

What is the treatment?

The complex nature of migraines means that the treatments available are varied and differ from person to person. There is currently no cure for migraine.

What causes migraine?

There is no known cause for migraine, although most people with it are genetically predisposed to migraine. If you are susceptible to migraine there are certain triggers which commonly occur. These include stress, lack of food, alcohol, hormonal changes in women, lack of sleep and the environment.

The most common types of migraine

The most common types of migraine fall into two categories - migraine with aura and migraine without aura.

What is aura?

Aura is a term used to describe a neurological symptom of migraine, most commonly visual disturbances. These can be:

• blind spots
• coloured spots
• sparkles or stars
• flashing lights before the eyes
• tunnel vision
• zig zag lines
• temporary blindness.

Other aura symptoms can include:

• numbness or tingling
• weakness
• dizziness
• 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 the headache itself.

The stages of migraine

Migraines have well defined stages. Most people experience more than one phase. Not everyone will experience the aura stage and it is possible to have the aura symptoms without the headache. Each phase can vary in length and severity.

The stages are:

• 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.

• Aura Stage
  This may last from 5 to 60 minutes. Symptoms may include visual disturbances such as flashing lights or sensory symptoms such as pins and needles.

• Main Attack Stage
  This consists of head pain and associated features which can typically last anything between 4 and 72 hours. The head pain is typically described as throbbing and one sided.

• Resolution and Recovery Stage or Postdrome Stage
  Most migraines fade slowly although some can be resolved suddenly by vomiting, for example.

It is these stages and their symptoms which distinguish a migraine from a headache.

The importance of a diagnosis

There is no specific test which can diagnose migraine. Diagnosis will depend upon your doctor taking your medical history and ruling out other causes for the attacks.

It may sound obvious, but before you start any form of treatment you need to be sure that you are being treated for the right condition. If other medical conditions co-exist alongside your migraine this is important in terms of treatment. Certain drugs cannot be taken together for example. A confirmed diagnosis of migraine and appropriate treatment can help prevent some attacks from occurring and help you to control the remaining attacks more effectively.

Migraine diary

It is very important for you to visit your GP and give the doctor details of your migraines. Keeping a record of these can be very helpful in assisting your doctor to have a clear picture of your migraines. This may include information on:

• when the head pains started
• how often they happen
• if there are other symptoms (such as being sick or having vision problems)
• how long the attacks last
• where the pain is
• whether the pain is throbbing, piercing

It is helpful to record as many aspects of daily life as possible, such as:

• what and when you eat
• your medication
• vitamins or health products you take
• any exercise you take
• how much sleep you have
• other factors such as the weather.

Women should record details of their menstrual cycle. It is often useful noting if you did anything different prior to the attack. The 6-8 hours before the migraine attack are particularly important to record.

Start recording your migraine attacks now with an online migraine diary or read our Migraine Diaries fact sheet.

Different types of migraine

The following charts summarise the different types of migraine as classified by the International Headache Society. This information is intended as a guide only and every type may not fit the criteria listed. Not everyone will have a ‘typical’ migraine. The experience of the condition will be unique to you.

Chart 1 - The Most Common Types of Migraine:

	Migraine without Aura Former Names: Common Migraine Hemicrania Simplex	Migraine with Aura Former Names: Classic or Classical Migraine Focal Migraine Ophthalmic Migraine Hemiparasthetic Migraine Aphasic Migraine Migraine Accompagnee Complicated Migraine
Common Symptoms	Attacks 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 take everyday exercise such as walking or climbing stairs. During this type of migraine you will be likely to feel sick and may vomit or have diarrhoea. You may also become sensitive to light (photophobia) and/or sound (phonophobia).		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. These symptoms include visual disturbances such as flashing lights or blind spots in the field of eyesight, tingling, numbness or pins and needles in the arms and legs, speech problems or weakness on one side of the body. These symptoms may also occur with a mild headache only or even no headache.
Likely Frequency of Attacks	May occur anything from once a year to several times per week.		May occur anything from once a year to several times per week.
Prevalence	70-90% of people with migraine experience this type.		10-30% of people with migraine experience this type.

Chart 2 - Other Types of Migraine:

There are other types of migraine which are less common.

Name	Comments	Common Symptoms
Retinal Migraine	Recurrent attacks at frequent intervals that only involve one eye.	Acute head pain with blind spots or blindness in one eye and other visual disturbances.
Abdominal Migraine	This type of migraine usually occurs in children and describes recurring attacks of abdominal pain which last anything from 1 to 72 hours.	Symptoms include loss of appetite, nausea and vomiting.
Menstrual Migraine	Many women feel their migraine attacks are linked to their menstrual cycle. Menstrual migraine is a specific condition where the attacks occur between two days before a period starts or finishes and at no other time.	Head pain within two days of a period starting or finishing and at no other time.
Status Migrainosus	This is a medical term for debilitating migraines which last several weeks. This is also known as intractable migraine.	A severe migraine which lasts for an extended period (several weeks).

Chart 3 - Rarer Types of Migraine with Aura:

Name	Comments	Common Symptoms
Basilar-type Migraine Former Name: Basilar Artery Migraine	Studies on basilar-type migraine are limited.	The symptoms will include two or more of the following: visual disturbances in both eyes, speaking difficulties, hearing problems, tingling in the hands and feet, dizziness, vertigo and ringing in the ears.
Familiar Hemiplegic Migraine (FHM)	This condition has been linked to a genetic defect.	Temporary paralysis on one side of the body, coma, confusion, and drowsiness. The headaches can go on for 5 to 10 days. The symptoms can be mistaken for epilepsy.
Sporadic Hemiplegic Migraine (SHM)	This has the same symptoms as FHM but has no family link.	As for Familiar Hemiplegic Migraine.

 

References

• Silberstein, SD Lipton, RB Goadsby, PJ Smith, RT. Headache in Primary Care. Oxford: Isis Medical Media, 1999.
• MacGregor, A Migraine in Women, Revised Edition. London: Martin Dunitz, 2003.
• MacGregor, A and Wilkinson, M.  Family Doctor Guide to Migraine and Other Headaches.  London: Dorling Kindersley, 1999.