There are many different types of migraine or headache disorders. The list of different types of migraine and headache disorders is below with their typical symptoms as well. Because many of them overlap, or for the overachievers who have multiple different types of headache, it’s best to get diagnosed by a headache specialist. This is usually a neurologist that has spent an additional year of training, called a fellowship, studying headache medicine. The best way to get a proper diagnosis of the type of migraine you have is to see a certified specialist. You can find them using this link from the American Migraine Foundation.
I have been seeing a headache specialist for years and the difference is marked. These doctors have a special interest in treating different types of migraine and headache disorders. Just like other neurologists might have a special interest in stroke or multiple sclerosis. It’s best to see a doctor that understands, on a higher level, different types of migraine and headache and all that accompanies them. Especially if you have a chronic form of migraine which can occur with any of the types listed below.
The Phases of Migraine
There are four phases of migraine: prodrome, aura, headache and postdrome. Not everyone will experience all of these phases each time they have an attack. Migraine is commonly thought to be a ‘bad headache’, but if you ask those that experience it, you will find that the head pain part might not be the worst symptom or might not even be present. Migraine Strong is part of the migraine community’s effort to reframe and reeducate the public on what migraine actually is, which is way more than just a bad headache. The graphic below is from the American Migraine Foundation. It shows the progression of an attack and what can happen in each phase.
Causes of Migraine
While doctors and researchers don’t know the exact cause of different types of migraine, they do know that there are some changes that happen in the brain during the actual migraine attack. A chemical in our bodies called serotonin plays a role in migraine. It acts on the blood vessels and when serotonin levels are elevated, the blood vessels will constrict or shrink. When serotonin levels decrease, the blood vessels will dilate or swell. This can trigger pain or other symptoms of migraine.
There is also another theory of migraine being researched that indicates there is electrical activity that gradually spreads across the brain – cortical spreading depression. Genes play the largest role in who will develop migraine. The American Migraine Foundation puts your risk of developing migraine at 50% if you have one parent with migraine. If both parents have migraine, your risk rises to 75%. Genetically, some of us are predisposed to experiencing different types of migraine with 90% of people with migraine having a family member who has migraine as well. It seems the best information at this time is that migraine is mainly caused by your inherited genes and triggered by the environment and lifestyle factors.
Common Triggers For Different Types of Migraines
Many of us with migraine can point to at least a couple of variables that can trigger an attack for us. These include, but are not limited to, certain foods, caffeine, weather, hormones, lack of sleep, stress or stress let down, smells/odors and bright lights. Flickering candles will trigger me most of the time if they are in my sight line and centerpieces that obscure part of another persons face is also a trigger. Imagine trying to explain why you have to move the centerpiece at a dinner party, not to mention the food triggers you are trying to avoid. And heaven forbid someone has those cinnamon pine cones that are so popular around the holiday seasons. That is an instant trigger for me and I can’t be around them at all. Navigating life with migraine can be tricky and irritating for all those involved.
Treating Different Types of Migraine
The treatment for different types of migraine and headache disorders varies but has similar underlying features. We frequently recommend minimizing the effects of different triggers through lifestyle changes and medication intervention. Ensuring that we have good sleep, regular movement (exercise), a migraine friendly diet, eliminating caffeine, limiting acute medications and use of preventive medications can help us reduce our overall frequency and severity of attacks. We call all of this the Treatment Pie.
The topic I wish we heard more about is ways to avoid progressing from episodic to chronic migraine. If you are currently episodic, please read this article to help minimize your chances of progressing to chronic. Avoiding the overuse of medications can go a long way to stopping this progression.
Different Types of Headaches and Migraine – The Facts
Migraine Without Aura
- Migraine without aura is experienced by 70-90% of those with migraine.
- Attacks can last 4-72 hours
- Head pain is most often on one side and a throbbing or pulsating type of pain. Pain is increased by every day activities like climbing stairs or walking.
- Most people experience sensitivity to light (photophobia) and/or sound (phonophobia).
- Attacks could occur a couple of times a year to multiple times per week.
- Some have nausea, vomiting or diarrhea.
- Used to be called common migraine.
- Frequently misdiagnosed as sinus headache.
Migraine With Aura
- 10-30% of those with migraine experience migraine with aura.
- Aura is usually visual and it is a neurological symptom that accompanies migraine.
- Visual Aura can last from 5 to 60 minutes (these symptoms can include: blind spots, sparkles, colored spots, flashing in both eyes, tunnel vision, temporary blindness and zig zag lines).
- Other aura symptoms include weakness on one side of the body, dizziness, pins and needles or tingling in arms and legs as well as numbness, a feeling of external vertigo (spinning) or internal vertigo (swaying).
- Speech and hearing can also be affected and occasionally fainting or paralysis.
- All aura symptoms are neurological in nature and resolve before the head pain does.
- It’s possible that no headache will follow aura symptoms
- Attacks could occur a couple of times a year or multiple times per week.
- Used to be called complicated or classic migraine.
- Most often diagnosed in children with the first attack typically happening between 3-10 years of age.
- Abdominal migraine is typically outgrown, but is more common in children with a family or personal history of migraine.
- Symptoms include, recurring attacks of moderate to severe stomach pain lasting between 1-72 hours. Other symptoms can include, nausea and/or vomiting, pale appearance, dark shadows under the eyes and lack of appetite.
- Kids who have abdominal migraine will typically experience traditional migraine later in life.
- Abdominal migraine attacks can be treated with the same medications that are used to treat traditional migraine and sometimes preventive medications will be prescribed if the attacks are frequent or severe.
- Headache that occurs 15 or more days per month, for three months, with at least eight being migrainous in nature (without rebound/medication overuse).
- Approximately 4 million people experience chronic migraine in the US. 85% of those people are women.
- Approximately 4% of the world’s adult population has chronic migraine.
- 2-5% of people with episodic migraine (less than 15 headache days per month) will transition to chronic migraine every year.
- Many people with chronic migraine have symptoms every day with one attack resolving as another one starts, never having a break from migraine symptoms.
- Risk factors for progression from episodic to chronic migraine are: anxiety, caffeine use, depression, obesity, snoring, stressful life events and acute medication overuse.
- Chronic migraine is the 6th most disabling condition on the World Health Organization’s list of disabling diseases.
- Many seek disability due to being incapacitated for more than half the month. Steady work is difficult in these circumstances.
- Menstrual migraine occurs only during the menstrual cycle, not at other times of the month.
- Menstrually related migraine is more common and occurs during the menstrual cycle specifically and periodically throughout the rest of the month.
- It is estimated that fewer than 10% of women have the specific condition of menstrual migraine.
- Menstrual migraine is thought to be triggered by a decrease in estrogen and an increase of prostaglandins.
- This typically happens two days before menstruation starts and the first three days of their period.
- Keeping a headache diary for three months can help the doctor determine if you have pure menstrual migraine or menstrually related migraine. There are no tests that will confirm the diagnosis so this diary can be very important.
- Vertigo, dizziness or balance issues are typical for vestibular migraine.
- Vertigo is considered a sensation of movement. Swaying is considered to be internal vertigo and a spinning sensation is external vertigo.
- Other common migraine symptoms are usually present as well such as, photophobia (sensitivity to light), phonophobia (sensitivity to sound), nausea and/or vomiting, sensitivity to movement, head pain, allodynia (unusual pain that is brought on by a light touch).
- Although head pain does not always occur with each attack, a history of migraine with head pain is usually part of the diagnosis.
- In most cases, there is also a history of car sickness.
- Dizziness and balance issues, along with other VM symptoms, are also common across the other different types of migraine as well. This makes getting a diagnosis of vestibular migraine even harder.
Migraine With Brainstem Aura
- Previously called basilar-type migraine.
- Considered to be a sub-type of migraine with aura.
- Symptoms include, vertigo, dysarthria (difficulty in controlling muscles that produce speech causing slurring or mumbling), tinnitus (ringing, buzzing or humming in the ears), hyperacusis (difficulty dealing with and increased sensitivity to everyday sounds), tingling in hands and feet, visual disturbances in both eyes, ataxia (inability to control the muscles).
- Has similar symptoms of, and can be mistaken for, stroke.
- Symptoms include, pins and needles feeling that begins in the hand and moves up the arm, numbness on one side of the body or face, weakness or paralysis on one side of the body, severe throbbing pain on one side of the head (although this may not be present, it can occur before or after the weakness) loss of balance or coordination, nausea and/or vomiting and dizziness or vertigo.
- Communication can be difficult due to slurred speech, mixing up words or confusion.
- Loss of consciousness, extreme sensitivity to light, smell and sound and vision issues which include zigzag lines or even blind spots.
- A thorough evaluation must be done to rule out stroke.
- A significant difference between stroke and migraine aura is the stroke symptoms occur suddenly and aura ramps up slowly.
- Includes visual disturbances that only occur in one eye.
- The attacks include, temporary blindness, seeing twinkling lights or areas of lost or decreased vision. Vision in the non affected eye will be normal when the affected eye is closed.
- Symptoms are generated from the eye whereas traditional migraine with aura is generated in the brain and therefore affects both eyes.
- Headache will typically begin within 5-60 minutes of the visual disturbance.
- Sometimes confused with silent migraine type.
- Thorough evaluation of the eyes is required to rule out other conditions.
Silent Migraine or Typical Aura Without Headache
- Occurs without head pain.
- People experiencing silent migraine can have all of the symptoms of migraine listed above.
- Will experience the prodrome, aura and postdrome phases and skip the headache phase.
- Even without the head pain, silent migraine can be very debilitating.
Ice Pick Headache (Primary Stabbing Headache)
- Single or multiple stabbing sensations that occur without warning.
- They last around three seconds, but might occur multiple times in a day.
- The stabbing sensations will move about the head. If they only occur in one place, they should be evaluated to make sure there isn’t a structural problem in the brain.
- Most of the time doesn’t require treatment. If they occur frequently, they can sometimes be treated with indomethacin or melatonin.
- Commonly called suicide headache for the severe pain involved.
- Extreme pain around and behind the eye.
- Other symptoms include, facial flushing, nasal congestion and tearing from one eye.
- During a cluster flare, the pain is usually experienced at the same time each day, but can happen every other day or up to eight times a day. Flares can last 4-12 weeks and usually happen in spring and fall. Others have chronic cluster headaches that don’t resolve and continue to happen daily.
- The pain will increase to an extreme level in 5-10 minutes and will usually resolve in 30-60 minutes. Some have the pain for up to 3 hours. Most people can’t stay still during and attack and will pace or even bang their head against a wall until the attack passes.
- More common in men than women.
- Oxygen is the most common treatment. Also sumatriptan injections and nasal spray and zolmitriptan nasal spray.
- Discuss the preventive treatments available for cluster headache with your doctor.
- This is considered a secondary headache or caused by another physical issue or illness.
- Not just a headache that is accompanied by neck pain. The term cervicogenic headache is frequently used incorrectly. There must be another issue present and diagnosed that can create these types of headache.
- These issues include, fractures in the cervical spine, infections, rheumatoid arthritis of the upper cervical spine or tumors.
- Symptoms include, limited range of motion of the neck, pain appears when pressure is applied to certain places on the neck, pain can travel from neck or back of the head to the front of the head or behind the eye.
- Nerve blocks can be a helpful treatment and they tend to be diagnostic of the condition.
- Physical therapy and regular exercise can help this type of headache.
- Due to the neck pain many people with migraine experience, many assume that cervicogenic headache is the diagnosis. Neck pain is very common and is often a symptom of the migraine ‘system’ activating. This article explains neck pain and its relation to migraine.
Tension Type Headache
- Primary headache disorder.
- Mild to moderate pain.
- A steady ache or tightness across the forehead or on the sides and back of the head.
- Tenderness on the scalp, neck and shoulder muscles.
- Typically not severe and is not made worse by routine physical activity.
- Also is not made worse by light and sound.
- Primary chronic daily headache disorder.
- Symptoms include, mild to moderate one sided pain (that doesn’t change) with occasional spikes of severe pain, tearing from the eye, redness and eye lid drooping and nasal symptoms (running or stuffiness).
- More typical in women and usually starts in adulthood, but some kids have been diagnosed.
- All people with HC respond positively to the medication indomethacin.
- Keeping a diary can be helpful in diagnosis. Note the location of the pain, when it started to become worse, how long the spike lasted, and the other non pain symptoms that occur.
- Rare primary headache disorder that typically occurs after age 40.
- Nicknamed the alarm clock headache because it wakes people from sleep at the same time each night, usually between 1:00-3:00am.
- Attacks typically last 30 minutes to six hours. And sleep can be resumed once the attack has subsided.
- More than one attack can occur per night. They can become chronic with 15 or more occurring in a month.
- Initial treatment includes caffeine (coffee at bedtime) or indomethacin.
Medication Overuse Headache (Rebound)
- Acute medication use on more than 10 times a month (2 or 3 days a week) for three months straight can trigger medication overuse headache (MOH).
- The rebounding effect from these medications happens when the medication wears off and the head pain comes back which leads to even more medication being taken. The medication then starts to trigger head pain instead of helping it.
- MOH occurs in people who have a history of migraine or headache disorders, but not others who take medication for back pain with no history of different types of migraine or headache disorders.
- The pain from MOH is a dull constant headache that is frequently worse upon waking.
- When the medication is stopped, it’s common for daily headache to occur until the body adjusts to not receiving the expected dose.
- The only way to treat MOH is to stop taking the medications that are causing it.
- Doctors can help you stop taking these medications and get through the pain that accompanies the process.
- 90% of self diagnosed sinus headache is really migraine with sinus symptoms.
- Symptoms include nasal congestion, runny nose, pressure in the forehead and over the sinuses and headache.
- True sinus headache is caused by a viral or bacterial infection and is accompanied by thick and colored discharge from the nose.
- Fever is frequently present.
- OTC medications can help to relieve pain and pressure. These also can be helpful with migraine.
- Sinus headache is likely migraine 93% of the time if the headache makes functioning difficult, or if the headache is associated with nausea or sensitivity to light.
- Most common trigger complaints are change in weather, stress and menstrual cycle…all migraine triggers.
- People with allergic rhinitis are 10% more likely to have migraine.
Conclusion On Different Types of Migraine and Headache Disorders
Many of the different types of migraine and headache disorders have overlapping symptoms. It is so important to see a qualified specialist to help you determine which migraine variant or headache disorder you might have. Migraine is a very complex disease and the ideal treatment is frequently not simple. If you feel like you aren’t getting better, or maybe you are getting worse, reach out to a neurologist or headache specialist who should be able to help. If you would like to continue the discussion with people that just get you, join our private Facebook group called Migraine Strong. We’d love to hear about your migraine journey.