There’s more to a migraine than just a headache.
Have you ever had a migraine?
If you’re one of the 38 million Americans who suffer from migraines, you’re probably more concerned about how to prevent and stop a headache than you are about the different types you might get. That’s understandable, considering how painful and debilitating migraines can be.
However, about 20 of migraine sufferers deal with unusual types—and knowing if you’re experiencing an out-of-the-ordinary migraine can help tailor your treatment and prevent future episodes, says Noah Rosen, MD, director of the Headache Center at the North Shore Long Island Jewish Health System in Manhasset, NY.
“One important thing to remember about migraines is that oftentimes the associated symptoms can be even more impairing than the migraine pain itself,” says Rosen. “Knowing what type of migraine you have can give you greater insight into the true causes so you can better manage those symptoms.”
Here, seven types of migraines that may not sound too familiar, and the best way to treat each.
Ocular migraine (aka retinal migraine)
This type of migraine is characterized by recurrent bouts of visual disturbance in one eye, says Brian Grosberg, MD, director of the Montefiore Headache Center in New York City. “This may include blind spots, blindness or flashes or sparkles of light.” The good news? Symptoms are often painless and temporary, adds Gary Heiting, OD, an eye care provider and senior editor of All About Vision. “You might have the sensation of looking through a cracked window, or see a small, enlarging blind spots in your central vision with bright flashing or flickering lights or wavy, zig-zag lines,” he says. “These symptoms usually last about 30 minutes.” However, if you have a visual disturbance that sounds like this followed by a throbbing headache, that’s actually a classic migraine with aura—not a retinal migraine, says Heiting.
💊 How to treat it: Though this type of migraine can be extremely frightening, they’re typically harmless and resolve on their own without medication within 20 to 30 minutes, says Heiting. If you deal with these often, avoid potential migraine triggers, such as too little or too much sleep, stress, skipping or delaying meals, odors, certain foods and alcohol, says Dr. Grosberg.
With this type of migraine, sufferers experience motor weakness (but it’s fully reversible). For example, your migraines may be accompanied by episodes of one-sided whole body paralysis that may outlast the headache itself. Scary but true: this type of migraine is actually more common in infants and children than in adults, and can be quite difficult to diagnose due to its complexity.
💊 How to treat it: See a doctor immediately, since the symptoms of this type of headache can be similar to stroke. Your doc may prescribe a calcium channel blocker to help reduce the number and severity of future attacks, says Dr. Rosen.
Migraine with brainstem aura (formerly known as basilar migraine)
You know you’re dealing with this type of headache when your aura (a fully reversible neurological symptom associated with the migraine headache) consists of at least two of the following symptoms, says Dr. Grosberg: slurred speech; vertigo; tinnitus (ringing in the ears); double vision; gait imbalance; and/or a decreased level of consciousness.
💊 How to treat it: Acute treatment may include medications such as nonsteroidal anti-inflammatory drugs or a peripheral nerve block; preventive treatment may include verapamil, topiramate or lamotrigine.
As if the mood swings and cramps that can accompany your period aren’t bad enough, menstrual migraines can also surface this time of the month, says Merle Diamond, MD, president and managing director of the Diamond Headache Clinic in Chicago. “About 60 percent of women who get migraines report headaches during their cycle,” says Dr. Diamond. “They may get others throughout the month, but their migraines are often worse and most frequent around their period, likely due to hormonal fluctuations.” Rosen adds that there’s also such a thing as a true menstrual migraine, which only happens during a woman’s cycle and typically occurs anywhere from two days prior to a period starting to one day into your cycle. If this happens to you during two out of every three cycles you have year-round, you officially have a true menstrual migraine.
💊 How to treat it: A couple days before you anticipate a headache, take neproxin (a preventive migraine medication) and continue taking it five days through your cycle, says Dr. Rosen. If you don’t see results, try nonprescription nonsteroidal anti-inflammatory drugs, or speak to your doctor about targeted anti-migraine meds if your symptoms don’t respond to adequate doses of NSAIDs.
This is most common in children and adolescents, says Dr. Diamond, and is often a sign that the child will go on to develop migraine headaches. These typically involve recurrent episodes of severe nausea and vomiting that are sometimes associated with abdominal pain near the navel or midline and don’t include an actual headache. What’s more, abdominal migraines tend to happen regularly (say, for example, every six weeks). Because these types of migraines are tough to diagnose (since there are many other causes of stomach pain), your doctor will ask if you have a family history of migraines.
💊 How to treat it: Low dose beta-blocker medications can be used to help diminish the frequency of future attacks, says Dr. Diamond, and go-to anti-migraine meds (such as NSAIDs, triptans, and antiseizure medications) can help stop an abdominal migraine in its tracks.
Most of us know about the nausea, vomiting, light and noise sensitivity, and throbbing pain associated with migraine headaches, but somewhere between 30 percent and 60 percent of migraine patients also experience extreme sensitivity to motion and dizziness. “Nearly 20 percent of these patients also experience serious vertigo that may lead to fainting episodes,” says Dr. Diamond.
💊 How to treat it: While the same preventive and abortive migraine treatments are used to treat vestibular migraines, patients can also benefit from physical therapy to help promote good balance, says Dr. Diamond.
Most people who get migraines regularly have one or two painful episodes a month—a burden, for sure, but most are able to carry on with work and their lives. For those with chronic migraines, though, the condition can be truly disabling. Chronic migraine is defined as experiencing migraines 15 or more days a month; research suggests about 1 percent of the population has this condition.
💊 How to treat it: In May 2018, the U.S. Food and Drug Administration approved a new class of drugs to prevent chronic migraine. It reduces the number of migraines in people who get them often, but it’s unlikely the drug would eradicate them altogether, so it may be used in combination with other therapies. Other chronic migraine treatments include Botox, acupuncture, antiseizure medications, and biofeedback.