Migraines are never run of the mill. However, certain types of migraines can cause additional symptoms. These symptoms can range from stomach pain to vertigo to stroke-like symptoms. We’ll discuss more about these five largely-unknown types of migraines:
- Silent migraines
- Hemiplegic migraines
- Ocular migraines
- Abdominal migraines
- Vestibular migraines
1. Silent migraines: Headaches without pain
It’s an age-old riddle: if a tree falls in the forest and no one is around to hear it, does it make a noise? Apply that enigma to migraines: if a migraine doesn’t hurt, is it really a migraine? If it’s a silent migraine, the answer is yes.
What is a silent migraine?
These types of migraines are accompanied by many symptoms of migraine, but without the pain and with distinct visual symptoms. The best way to decode this medical anomaly is to look at the four phases of migraine.
- Prodromal: This phase, usually occurring about 24 hours before a migraine, is when the body tells the sufferer that a migraine is on the way. Patients may feel more irritable or confused. They may also be very thirsty or suffer from diarrhea. Only about 25% of migraine sufferers have this “early warning” system.
- Aura: There are unusual visual symptoms in this phase, and 20% of sufferers experience them for about an hour. Other sensory, motor, or language disruptions can also happen during this phase.
- Attack: Most familiar of all of the phases, migraine pain is usually throbbing and comes with nausea and vomiting. Sensitivity to light and sound also occurs, and this phase can last anywhere from a couple of hours to several (miserable) days.
- Postdromal: The migraine is over, but the after effects of fatigue and sadness can linger for a few days.
The following video shows these four migraine stages.
What makes a silent migraine different?
This is a general guideline of how migraine works, but it can vary from person to person and even from episode to episode for the same person. A silent migraine includes all of the above phases, minus the pain, and with a few extra physical symptoms.
Silent migraine sufferers may experience extremes of the following physical symptoms:
- Food cravings and loss of appetite
- Extreme thirst and frequent urination
Their visual symptoms in phase one can also be extreme. They may include wavy lines or floating dots, flashing lights, hallucinations, difficulty with speech, and tunnel vision. Silent migraine sufferers may also temporarily lose their speech, may experience auditory hallucinations, and may have a distorted sense of smell or taste. A silent migraine is a full sensory experience that can be enough to limit the ability to function. They can last anywhere from an hour or two to several days, just like types of migraines with pain.
What are silent migraine causes?
Researchers are beginning to look at migraines as more than just a vascular condition, focusing on the aura of silent migraine as a neurovascular event.
This means that silent migraine may have something to do with overstimulation and then suppression of nerve activities in the brain. This may lead to increased sensitivity and heightened or changed function in those areas of the brain that control the senses. The visual component seems to be the key to distinguishing a silent migraine from another condition.
How are these types of migraines treated?
Silent migraines appear to be triggered by the same things as regular migraines (i.e., stress, fatigue, food sensitivity, hormonal changes, or changes in weather) and can be treated in much the same way. Treatments include plenty of rest, preventative care, and regular exercise. MRIs may be necessary to rule out the possibility of a more serious problem like stroke or bleeding in the brain.
2. Hemiplegic migraines: Migraines with paralysis or weakness
Hemiplegic migraine is known as a subgroup to a major migraine classification called migraine with aura. It is a very rare condition that only affects about 0.03% of the U.S. population. A hemiplegic migraine is, however, one of the most dangerous types of migraines as it can cause severe weakness or paralysis in one side of the body, confusion, disrupted vision, and mimics symptoms that are similar to stroke.
What is an hemiplegic migraine?
The word hemiplegic means paralysis on one side of the body, which usually includes the face, arm, and legs and can range from pins and needles feelings to complete numbness. The most frightening part about this disorder is that it can disable a person’s ability to speak, which can be problematic in many instances, especially when a patient is receiving emergency care.
Migraines in general are complex and hemiplegic migraines are no different. Usually the actual migraine event is preceded by a host of symptoms, called auras, which can include problems affecting vision, speech, muscle control, and hearing.
What are hemiplegic migraine symptoms?
Typically, symptoms last between five minutes to an hour. The aura for this disorder, however, lasts longer than most other headaches and it is possible for these effects to last for a few days or even weeks. Symptoms for hemiplegic migraine include:
- Severe, throbbing pain on one side of the head
- Weakness or paralysis on one side of the body
- Numbness on one side of the body
- Loss of balance and muscle control
- Visual disturbances, such as double vision or blind spots
- Sensitivity to light and sound
- Slurred speech or mixing up of words
- Dizziness, nausea, and vomiting
Hemiplegic migraine is an erratic disorder, and can have unique effects from one headache to the next. This can include the pain from the headache being minimal or severe, as well as the paralysis effects being mild to severe. There is also a possibility that these temporary symptoms, like loss of muscle control and coordination, could become more permanent although this is quite rare.
What are hemiplegic migraine causes?
If these types of migraines weren’t already complex enough, there are also two variants of hemiplegic migraine. They are called:
- Sporadic hemiplegic migraine (SHM)
- Familiar hemiplegic migraine (FHM)
Familiar hemiplegic migraines are defined by two or more people in the same family experiencing migraines that include temporary paralysis on one side of the body. 50% of children born to a parent with FHM have a chance of inheriting the disorder. Furthermore, three distinct genes have been identified in connection with FHM: CACNA1A, ATP1A2, and SCN1A. Mutations in any of these genes can lead to a breakdown in the communication process for nerve cells, which can result in a disruption of the release and uptake of certain neurotransmitters in the brain. This is believed to be the cause of the numbness in the body as well as the headaches.
The less common condition, sporadic hemiplegic migraine, is defined as someone who has symptoms aligning with FHM, but does not have a family member or history of this condition. Many people with these types of migraines do not have a mutation in these known genes and it is currently unknown what the underlying cause is. Scientists believe defects in other genes are a possible cause, but have yet to identify them.
How are these types of migraines diagnosed?
If you start to experience these symptoms, consult a medical professional. This is especially important considering that other serious conditions also have similar symptoms. Since hemiplegic migraines are quite rare, it can often be diagnosed as stroke or epilepsy and it will be the first diagnoses that must be ruled out.
Hemiplegic migraines are diagnosed by running various tests to exclude other conditions, such as checking for blood clots and signs of stroke using a CT scan or MRI. Doctors rely on an accurate history and recount of symptoms as well, so make sure you have that information available when you see your doctor. Genetic testing can also be useful as it can help verify a diagnosis of familial hemiplegic migraine.
The International Headache Society has published a standard guideline that is widely recognized as the go-to for physicians. It states that in order for a hemiplegic migraine to be diagnosed, it must be a migraine with aura that includes motor weakness. It also lists multiple other criteria that can be found on their website. These include speech disturbances, visual symptoms, and sensory numbness.
What hemiplegic migraine treatments are available?
Treatment for hemiplegic migraines are very similar to standard treatments for migraines overall. They consist of using medications such as non-steroidal anti-inflammatory drugs and narcotic analgesics for pain relief and calcium channel blockers to prevent migraine episodes. Occipital nerve blocks may also be suggested. Currently, vasoconstrictors are contraindicated since hemiplegic migraines are similar to strokes, but newer studies are starting to question this logic.
3. Ocular migraines: Migraines with visual symptoms
An ocular migraine can be a debilitating condition that is also known by other names, such as retinal, ophthalmic, and monocular migraine. This disorder is identified by numerous visual symptoms that occur only in one eye right before or during a migraine headache. This condition is sometimes confused with migraine with aura, which has similar symptoms, but occurs in both eyes simultaneously. Ocular migraine is a rare disorder that only affects about one in 200 migraine sufferers. However, these types of migraines can be quite limiting and potentially dangerous as they can interfere with a variety of activities such as reading, writing, and driving.
What happens during an ocular migraine?
Those who experience an ocular migraine can have a variety of symptoms occur that include the following:
- Attacks that occur multiple times creating monocular visual disturbances, including flashing lights (scintillations), blind spots (scotoma), or complete temporary blindness
- Comes with a headache that tends to affect one side of the head with a pulsating pain sensation that amplifies after physical activity
- Can induce nausea, vomiting, and sensitivity to light or sound
The key identification symptom for ocular migraine is that the visual disturbances only happen in one eye at a time, however, the visual effects can migrate within the same eye. Furthermore, this condition does not show any identifying markers or symptoms during an eye exam unless an attack is occurring, so it can be quite difficult to catch.
Fortunately, the visual disturbances are temporary and typically only last between a few minutes to around an hour. Unfortunately, the headache phase for this condition usually lasts between four and 72 hours.
Ocular migraines commonly affect adults in their 30s and 40s, but frequently start during puberty. This disorder is also three times more likely to affect women than it is men. About 60% of ocular migraine suffers also report that they have other leading symptoms that can occur days to weeks in advance. This includes subtle changes in mood, food cravings, and a general feeling of tiredness.
What are ocular migraine causes?
According to the research team from the Wellcome Trust Sanger Institute, there is a genetic factor that may come into play for these types of migraines. Other studies have shown that up to 70% of people who suffer from migraines have a family history of this condition.
There is no conclusive explanation on what causes ocular migraines to occur. Experts have conducted imaging studies that have shown that changes in blood flow occur during attacks, but the underlying reason is still a mystery. There are a few common triggers that can cause those who are vulnerable to migraines to suffer from an attack, such as food additives.
How are these types of migraines diagnosed?
There is currently no diagnostic test for ocular migraines. The best way to diagnose this disorder is to have an eye exam during an attack. A doctor will likely be able to see the decreased blood flow due to the eye constriction and make a diagnosis this way. Since attacks are usually brief and somewhat random, this is an unlikely method of diagnosis.
The most reliable way to diagnose this disorder is through a battery of tests to remove other likely causes. A physician also heavily depends on symptoms divulged by the patient for a correct diagnosis as well as an accurate medical history.
It is always advised to seek out a medical professional if you are starting to experience diminished vision or visual disturbances. This is very important if you believe you have ocular migraines, because these symptoms can be caused by even more serious conditions such as amaurosis fugax, sickle cell disease, polycythemia, or various autoimmune diseases. Once a doctor has ruled out other conditions, they are likely to consider ocular migraine based on your symptoms and International Headache Society standards.
How are ocular migraines treated?
To date, not a lot of research has been conducted on what medication will most effectively treat or prevent ocular migraines. There are many standard migraine medications that can be used to treat the symptoms of an ocular migraine, though. These include NSAIDs, beta-blockers, tricyclic antidepressants, and medications that treat epilepsy.
4. Abdominal migraines: Learn the basics
Abdominal migraines are a type of migraine that mainly occurs in children and adolescents, although, they can occasionally be found in adults. An abdominal migraine causes chronic abdominal pain along with other symptoms, but oddly does not present with pain or throbbing in the head that is typical in other migraine disorders. This condition is important to be aware of because recurring abdominal pain is one of the most common symptoms in young children today.
What are abdominal migraines?
Abdominal migraines occur most often in children who have a family history of migraines and typically start between the ages of two and ten. It is believed that 2% of children get abdominal migraines and, according to the American Headache Society, 4-15% of children who present with chronic abdominal pain actually have abdominal migraines. Women have a higher frequency of being diagnosed with this condition and children who experience abdominal migraines are at a higher risk of developing migraine headaches as adults.
Symptoms for abdominal migraines are quite atypical when compared with other migraine disorders. Children who suffer from this condition do not get the classic headaches along with the stomach pain, but they also do not get any preceding symptom, called auras, either. In fact, the abdominal pain and other effects are most often severe and abrupt rather than slow-to-build before an episode.
What are their symptoms?
The main symptom that gives this condition its name is intermittent pain throughout the abdominal region that can be quite severe in intensity. This pain is usually not localized and is often described as dull or sore. The abdominal pain may last for an hour or as long as three days. Additional symptoms of abdominal migraines may include:
- Pallor, sudden paleness of the skin most often located in the face and palms
- Inability to eat
What are abdominal migraine causes?
The exact cause of this condition is not well-studied or understood, but it is believed that this disorder is affected by neurologic and hormonal factors. Researchers think that abdominal migraines may be caused by the changes in the levels of two chemicals, serotonin and histamine. Furthermore, genetics seems to take an important role, as up to 60% of children with this condition have parents with some form of migraine disorder.
Like classic migraines, abdominal migraines have various triggers that can set off an attack. Stress is a common example and includes things like anxiety and worrying, but overstimulation or high excitement can also cause an episode. These tend to vary from person to person, but the following list are common triggers among children:
- Car sickness
- Skipping meals or any kind of fasting
- Bright or flickering lights
- Excessive swallowing of air
- Any strenuous physical activities
- Poor sleep hygiene
- Certain foods such as aged cheese, preserved meats, chocolate, and monosodium glutamate (MSG)
How are these types of migraines diagnosed?
Since the cause of abdominal migraines has yet to be discovered, there is no sure-fire test to diagnose this condition. This is even more problematic as the main source of information about the symptoms comes from young children who usually cannot distinguish between a normal stomach ache or gastrointestinal illness and the pain that comes with this disorder. Using child-specific pain scales can help.
Headaches are rare with this condition as well so the only way to diagnose it is to exclude other causes of stomach pain first. This is accomplished by running a battery of tests, including imaging scans and EEG. Doctors will use the patient’s family medical history to assist in making an accurate diagnosis. Finally, there must be no other underlying cause that could explain the abdominal pain.
How are abdominal migraines treated?
The main approach taken by physicians combating this disorder is to relieve any presenting symptoms, while also developing a plan that will help stave off future occurrences. Today, there is no specific medical procedure or medication that is used in the treatment of abdominal migraines.
Typically, doctors will use medications that are effective in other migraine scenarios. This includes typical over-the-counter drugs like NSAIDs, many kinds of medications that appear in the triptan classification, drugs that block the effects of serotonin, antidepressants, and anti-seizure medication.
5. Vestibular migraine: Migraine with vertigo
Vestibular migraine is a type of migraine headache that adds a complicated symptom: dizziness and vertigo. The causes of this type of migraine are unclear, but there is a connection between migraine and the inner ear. The inner ear is the organ that affects balance and equilibrium.
What is a vestibular migraine?
For a person who sufferers from these types of migraines, their equilibrium is thrown off during a migraine. Instead of pain being the main symptom of migraine, dizziness is most prominent.
Other symptoms of vestibular migraines include:
- Poor balance
- Muted hearing
- Ringing in the ears (tinnitus)
- Extreme motion sensitivity
Any of these symptoms can lead to fatigue and nausea, but in general pain is not present. A vestibular migraine can last anywhere from days or hours.
Dr. Susan Broner, an attending neurologist at Roosevelt Hospital’s Headache Institute in New York City, describes the symptoms of this migraine like this:
“Vestibular migraine is a variant of migraine in which instead of headache being the most predominant feature, dizziness is. Patients usually say that out of nowhere they got extremely dizzy and don’t feel like they’re on even ground. Some describe a spinning or rocking sensation. They have light or sound sensitivity and get nauseous or throw up.”
What are vestibular migraine causes?
There are several theories as to what causes vestibular migraine.
- Blood vessel spasm: Vascular spasm in the brainstem may cause vertigo.
- Changes in the neurotransmitters: As with most migraines, patients with vestibular migraine often have changes in serotonin levels.
- Disturbance in the cerebellum: Changes in the metabolism of the cerebellum may be a cause of vestibular migraine.
Patients who are extremely sensitive to changes in sensory detail – sound, light, and movement – are more likely to experience vestibular migraine than any other type.
Women are three times more likely to experience any kind of migraine than men, leading researchers to hypothesize that fluctuations in hormones play a role in causing migraines. A genetic predisposition may also be a cause of this type of migraine.
How are these types of migraines diagnosed?
Diagnosis of vestibular migraine can be complicated. As with most migraines, accurate patient reporting is key. In the case of vestibular migraine, there may be a misdiagnosis of Meniere’s disease or benign positional vertigo. Dr. Broner pointed out that although these conditions share similarities, these migraines are not quite the same, noting:
“There may be an overlap between Meniere’s and vestibular migraine. With vestibular migraine, people are exquisitely sensitive to motion, but they seem to be more sensitive to migraine triggers like fluorescent lighting or drinking wine. All the migraine triggers affect these patients; vestibular migraine is a disorder of exclusion—you have to rule out seizures and structural abnormalities—so it’s one of the clues.”
In other words, vestibular migraine is often diagnosed by process of elimination. In order to do this, doctors take a thorough patient history that includes any family incidence of migraine of any type. They may administer a CT scan or MRI to look for brain activity that indicates vascular involvement.
Because this type of migraine can involve the areas in the ear that deal with balance, patients may be referred to an otolaryngologist (ear, nose, and throat doctor) or an audiologist (to test for hearing loss or other symptoms of vestibular migraine).
What are vestibular migraine treatments?
There are two types of treatments for this condition: preventative, which we’ll discuss at the end of this post, and reactive treatments. For these types of migraines, many treatments during the attack phase include anti-emetics to control nausea and muscle relaxants.
Other treatments may include:
- Anti-inflammatory or triptan medications (which narrow blood vessels in the brain)
- Anti-anxiety medications
- Medications to treat vertigo
Vestibular migraine can be a seriously debilitating condition for those who suffer from it. Because it does not generally occur with pain, it is often misdiagnosed or underdiagnosed.
Preventing all types of migraines
Prevention is almost always preferred when compared to treating any of these types of migraines. One of the best ways to do this is keeping a food and activity pain journal to track possible triggers. This will also help identify patterns that can be used to avoid those triggers.
Common migraine triggers include:
- Food, such as aged cheeses, caffeinated beverages, smoked meats, chocolate, and wine
- Additives, such as monosodium glutamate (MSG) and artificial sweeteners
- Strong odors, cigarette smoke and perfumes
- Intense exercise
- High altitude
- High blood pressure
- Flickering or bright lights
- Lack of sleep
- Emotional distress
Finally, minimizing stress is always an important step. Learning to manage stress through healthy lifestyle habits can be the key to minimizing pain. The following video gives more information on preventing migraines.
If you suffer from any of these types of migraines, finding relief is important both for your quality of life and safety. While we’ve discussed some possible medications and prevention strategies for each, talking to a pain specialist can help you get the diagnosis and more interventional treatments you need to reduce your pain.
They may be able to suggest medications for your migraines. Or, they can discuss techniques like occipital nerve blocks that may relieve your pain. Any of these types of migraines can be considered chronic, as well, if they occur on eight or more days per month for more than three months.
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