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.