Atypical Migraine: What to Know

A Stigmatized, Under-Researched Subtype of Migraine

Medically reviewed by Nicholas R. Metrus, MD

"Atypical migraine" is a term used to describe a migraine that doesn't have the usual characteristics and symptoms of a migraine. Many people who occasionally have atypical migraines also have migraines that fit the standard migraine description, but there are characteristics that can distinguish atypical migraines from migraines.

Some features of atypical migraines include having migraine symptoms without head pain, having migraines without an aura, or having neurological symptoms (such as weakness of part of the body) along with the migraines.

This article describes the features of atypical migraines and warning signs that indicate a need for medical attention.

Problem With the Term “Atypical” Migraine

While “atypical migraine” is a commonly used term, this is not a diagnostic description or a medical definition. Atypical migraine is not one of the formal migraine classifications. However, if you have been told that you have atypical migraine, this generally means that there is something unusual about your migraine symptoms.

Most of the time, other medical conditions are considered as possible causes of the symptoms before an atypical migraine is diagnosed. You would likely have some diagnostic tests or be evaluated for other possible conditions before it’s established that you are having atypical migraines.

Learn More: What to Know About Migraine

Characteristics of Atypical Migraine Symptoms

Some atypical migraine characteristics are:

• Migraine symptoms without head pain (may include nausea, vomiting, neck and muscle aches, extreme fatigue, photophobia, and more)

• Not experiencing an aura with a migraine, especially if you usually have an aura with your migraines

• Having an age of onset that is not typical for migraines (such as over age 40)

• Experiencing symptoms that are typical of a stroke, such as paralysis or sensory loss on one side of the body

What Is a Migraine Aura?

A migraine aura is a neurological symptom that accompanies any stage of a migraine. It can include vision changes, weakness, numbness, slurred speech, and more. A migraine aura can feel very similar to a stroke.

If you have unexplained neurological symptoms, it's important to see a health care provider—because a stroke can result in death or disability if it's not treated promptly.

What Makes Atypical Migraine Different

Features that make an atypical migraine different from a standard migraine include having additional symptoms to those typical of a migraine, a lack of head pain, or an unusual pattern of migraine timing or age of onset.

Sometimes an atypical migraine can appear like a stroke. It’s very important for a stroke to be excluded as the cause—because a stroke requires prompt medical intervention.

How Atypical Migraine Differs From a Stroke

Differentiating an atypical migraine from a stroke involves a rapid process that includes a medical history, physical examination, and potentially diagnostic testing.

Features that can help differentiate a stroke from an atypical migraine include:

• A stroke is usually associated with stroke risk factors, such as heart disease, atherosclerosis (plaque buildup on the walls of arteries), untreated diabetes, and untreated high blood pressure.

• A stroke may have been preceded by a transient ischemic attack (TIA) in the past.

• A stroke may involve a combination of several neurological symptoms that correspond to an affected area of the brain—which can include one-sided weakness, sensory changes, vision changes, or language and communication impairment.

• Symptoms of a stroke will not improve with migraine treatments.

Because symptoms that can occur with a stroke or an atypical migraine are not always clear, a physical examination is necessary.

Characteristics of a stroke that can differentiate it from atypical migraine include weakness on one side of the body, a visual field defect, changes in reflexes, and objective sensory deficits.

Brain imaging tests can help differentiate between an atypical migraine and a stroke because a stroke usually will show changes on a brain computed tomography (CT) scan or magnetic resonance imaging (MRI), while an atypical migraine will not.

Related: New Stroke Symptom Acronym Says 'BE FAST' About Calling 911

Other Possible Conditions

Several other medical illnesses can produce symptoms similar to those of an atypical migraine. It may take extensive testing to distinguish atypical migraine from similar medical conditions.

Conditions that can be similar to atypical migraine include:

• Ear infection

• Brain tumor, or a tumor in the inner ear

• Hypotension (low blood pressure)

• Meningitis or encephalitis (infection or inflammation of the brain tissue or surrounding region)

• Seizure (episode of erratic electrical impulses in the brain)

• Multiple sclerosis exacerbation

Your medical evaluation will be based on your symptoms, risk factors, and physical examination.

Causes of Atypical Migraine

It’s not clear why some people are prone to having atypical migraines. In general, it is believed that migraines may have a genetic cause and can often be triggered or worsened by environmental factors.

Research suggests that some migraine subtypes might be associated with different genes, but there is no well-established genetic link to one subtype of migraine vs. the others.

How to Relieve Atypical Migraine Pain

Treatment for atypical migraines is similar to treatment with typical features. Usually, with migraine treatment, certain medications and therapies are more effective for some people than others. One of the difficulties of migraine treatment is that it is impossible to predict which therapy will be most effective for you.

Migraine treatment is based on two complementary approaches—acute treatments that you would take during migraine episodes and preventive treatment that you would use daily to avoid migraines.

Acute therapies that are usually effective for migraine relief include:

• Tylenol (acetaminophen)

• Nonsteroidal anti-inflammatories (NSAIDs), such as Advil (ibuprofen) or Aleve (naproxen)

• Excedrin Migraine (acetaminophen, aspirin, caffeine)

• Prescription treatments, which can include the antiemetics Fioricet (butalbital, acetaminophen, caffeine) and Fiorinal (butalbital, aspirin, caffeine); triptans like Imitrex (sumatriptan); and calcitonin gene-related peptide (CGRP) receptor antagonists like Nurtec ODT (rimegepant)

Preventive medications include:

• Antidepressant medications

• Antiepileptics, Neurontin (gabapentin), Tegretol (carbamazepine), and more

• Calcium channel blockers, Calan or Veralan (verapamil)

• Beta blockers, Tenormin (atenolol), Inderal LA (propranolol), and more

• Calcitonin gene-related peptide (CGRP) monoclonal antibodies, Vyepti (eptinezumab) and Ajovy (fremanezumab)

Lifestyle practices are also a crucial part of both prevention and treatment. This includes avoiding migraine triggers, getting enough rest, and managing stress.

Question to Ask a Provider

If you’re having atypical migraines, you may likely have some concerns about whether your condition is truly caused by migraine or whether you might have an underlying or concerning medical issue.

Questions that can help you communicate with a healthcare provider about your atypical migraines may include:

• What should I do if I develop unusual neurological symptoms?

• How would I know if I am having a stroke?

• Are there stroke risk factors that I should be managing?

• Is it possible that my episodes are a type of seizure?

• Should I take migraine prevention therapy?

• Are there any nonmedical methods that I can use to prevent atypical migraines?

Summary

Atypical migraines do not fit the typical description of a migraine. However, there is no specific diagnostic definition of an atypical migraine. If you have neurological symptoms with your migraines or migraine symptoms without a headache, you might have been told that you have atypical migraines.

The key feature of any migraine care is learning your triggers, considering whether you need preventive medication, and having access to effective treatment if you have a migraine.

Discuss stroke risk factors with a healthcare provider so that you can lower your risk of a stroke. Ask how to know when you should get medical attention if you develop symptoms.