Every Type of Migraine and How to Tell Them Apart

Migraine disorder is a neurological disease characterized by recurring headaches and other symptoms, including nausea, vomiting, and sensitivity to light and sound. It’s the third most prevalent illness in the world, and affects about 12 percent of the global population. Migraine episodes  can result in  severe, debilitating head pain, but they’re more than just a bad headache.

According to Rick Godley, a general otolaryngologist based in Rhode Island and president and founder of the Association of Migraine Disorders, migraine is caused by an overly reactive and sensitive nervous system, which can be genetic, triggered by external factors, or a combination of both. 

Jan Lewis Brandes, a neurologist and board member at the National Headache Foundation, says people have to meet at least two of these criteria to be diagnosed with migraine: pain that’s only on one-side of the head, is pulsing or throbbing, and a moderate to severe headache that is made worse by routine activity (for example, bending over). People also have to have one out of four associated features: nausea, vomiting, light sensitivity, or sound sensitivity. 

While a migraine diagnosis requires certain symptoms, people can experience migraine differently. Here’s every type of migraine, and how to tell them apart.

Episodic vs. Chronic Migraine

Deena E. Kuruvilla, a board-certified neurologist based in Connecticut and an executive board member of the Association Of Migraine Disorders, says doctors first categorize migraines according to their frequency, because the treatments can vary widely.

Episodic migraine, she says, which is characterized by fewer than 15 headaches a month, is the most common type. Usually, Kuruvilla explains, episodic migraine is easier to treat, because it comes with fewer headache days. “If [the patient is] having less than four headache days a month, we’d probably only use abortive medication, unless each individual attack is very disabling,” she says. 

When a person has 15 or more days of migraine a month, that qualifies as chronic migraine, which can be much more disabling. For people with chronic migraine, a doctor may prescribe one or multiple preventative medications to be taken daily, along with abortive medications to stave off headaches when they start to come on.

Migraine With Aura

According to Joseph Feuerstein, a board-certified family medicine physician specializing in integrative medicine based in Connecticut, migraine can be divided into two categories, depending on whether or not they have an accompanying “aura.”

Migraine with aura, which Brandes says occurs in about one in four patients, includes visual or sensory disturbances that usually occur before the headache. She tells Allure that some people have both types of migraine attack. “Typically, if you ever have aura with an attack, then you are labeled or diagnosed as someone who has migraine with aura,” even if you also experience migraine without aura, she explains.

The aura of a migraine usually lasts 10 to 60 minutes, and for many patients, it progresses leading up to the headache. Brandes says aura may begin with visual symptoms, like flashing lights or missing vision. Then, people may experience tingling in the face, hands, or arms, followed by difficulty with language — the feeling that you can’t get a word out even though you know it. Aura usually ends within 60 minutes, and if it goes longer, Brandes says a doctor may consider other diagnoses. 

Some people can even get aura without a headache, but Brandes says that’s a separate sub-type of migraine.

Migraine Subtypes

People with chronic or episodic migraines and migraine with or without aura can experience any migraine subtype. Some of the most common migraine subtypes include: 

Ocular migraine: According to Godley, an ocular migraine is a migraine attack, usually in one eye, where any number of visual distortions can occur for up to an hour. It may or may not occur with a headache.

“Often, an attack begins with a blind spot in the central area of vision, which can start small and get larger,” he says. “This is often followed by an aura stage with other visual distortions, such as what looks like a spot of light moving about in your peripheral and central vision, or a kaleidoscope view.”

Vestibular Migraine: Vestibular migraine, which may or may not include a headache, affects a person’s balance, causing dizziness, ear pressure, or ringing in the ears.

Godley explains that a vestibular migraine might also come with non-headache symptoms, like difficulty seeing, intolerance of bright lights and noises, neck pain and spasms, confusion, spatial disorientation, and increased anxiety. It mimics two other common balance disorders: benign paroxysmal positional vertigo and Meniere’s disease.

Hemiplegic Migraine (HM): People with hemiplegic migraine experience motor weakness during their aura, which Godley tells Allure is the main differentiating factor between HM and other migraine classifications.

The motor weakness, he says, is not always on the same side as the head pain, but it can be. Severe HM attacks may progress to more serious conditions, like seizure, decreased consciousness, or coma. 

Abdominal Migraine (AM): Abdominal migraine is a disorder, seen mainly in children, of repeated attacks of belly pain with nausea and vomiting, but with or without a headache.

Godley says these attacks last 2 to 72 hours with complete relief from pain between episodes. About two percent of all children may get AM, according to Godley, and most children with AM will develop classic migraine later in life.

Migraine with Brainstem Aura (MBA): Formerly known as “basilar migraine,” migraine with brainstem aura occurs when aura symptoms are of the type thought to originate from the brainstem, but there is no motor weakness associated with the aura.

According to Godley, diagnostic criteria for MBA is migraine with aura including at least two of the following symptoms: slurred or slow speech, vertigo, ringing in the ears, partial hearing loss, double vision (diplopia), impaired coordination, or decreased level of consciousness.

Typical aura without headache: Some people experience associated migraine symptoms without a headache, according to Feuerstein. Often called a “silent migraine,” a typical aura without headache features temporary visual, sensory, or speech symptoms, simply without the usual head pain.

Status migrainosus (SM): SM occurs, Feuerstein says, when someone has a migraine (any type) that lasts longer than three days. During status migrainosus, a person’s migraine — which could include a headache and other associated migraine symptoms — may not respond to interventions or medications that normally work.

No matter what kind of migraine you experience, it’s important to seek medical help. Brandes recommends keeping a headache diary to mark when you get your headaches and how severe they are. Make an appointment with a primary care provider or OB-GYN, if that’s who you see for primary care. And if your headaches are debilitating, consider a specialist, like a neurologist or a doctor who’s focus is on treating headaches.

The important thing is to find a clinician who really listens to you. “Managing migraines can be complex, especially for people with chronic migraines,” says Brandes. “It’s critical to have a clinical partner who recognizes that.”

Originally Appeared on Allure