Migraine is a complex neurological condition characterized by recurring moderate to severe headaches, often accompanied by throbbing pain, usually on one side of the head. It frequently presents with additional symptoms such as nausea, vomiting, and heightened sensitivity to light and sound. Atypical migraines are variations that manifest with unusual or prolonged neurological symptoms, or even without headache pain. These are not distinct conditions but diverse expressions of the underlying migraine disease.
Defining Atypical Migraines
Atypical migraines differ from typical migraines in their symptom presentation, often lacking the characteristic throbbing headache or exhibiting unusual neurological features. They may not meet all standard diagnostic criteria for classic migraine or deviate from its typical four-phase pattern. This can involve symptoms in areas of the body not usually associated with migraine, or a presentation that might mimic other neurological conditions.
These variations are sometimes referred to as “migraine variants” or “migraine mimics” because their symptoms can overlap with other serious conditions, necessitating careful medical evaluation. The distinguishing factor often lies in the nature of their aura, which may be unusually prolonged, particularly severe, or occur without headache.
Specific Forms of Atypical Migraine
Atypical migraines manifest in several distinct forms.
Migraine with typical aura without headache
Previously known as “acephalgic migraine” or “silent migraine,” this involves sensory disturbances of an aura without accompanying headache. Auras include visual changes like flashing lights, zigzag lines, blind spots, or shimmering patterns, lasting between 5 and 60 minutes. Other symptoms, such as numbness, tingling, or speech difficulties, can also occur.
Hemiplegic migraine
This rare form characterized by temporary weakness or paralysis on one side of the body (hemiplegia) as part of the aura. It can be accompanied by visual disturbances, speech difficulties, or sensory changes. It can be familial (Familial Hemiplegic Migraine, FHM), linked to specific genetic mutations, or sporadic (Sporadic Hemiplegic Migraine, SHM) without family history.
Retinal migraine
Also known as ocular migraine, this involves repeated episodes of visual disturbances affecting only one eye. Symptoms include temporary vision loss, blind spots, or flickering lights in a single eye, often followed by a migraine headache. These visual symptoms last from 5 to 60 minutes.
Vestibular migraine
Characterized by vertigo or dizziness, balance issues, and lightheadedness, which may occur with or without a headache. Episodes of vertigo can last from minutes to days and may be accompanied by nausea, sensitivity to sound, or visual disturbances. This is a common cause of vertigo.
Migraine with brainstem aura
Formerly termed basilar-type migraine, this involves aura symptoms originating from the brainstem. Symptoms include vertigo, slurred speech, ringing in the ears (tinnitus), double vision, or problems with balance and coordination. Unlike hemiplegic migraine, it does not involve motor weakness.
Chronic migraine
Defined by headache frequency, occurring when headaches are experienced on 15 or more days per month for at least three months, with at least eight meeting migraine criteria. This represents a progression from episodic migraine, where attacks occur less frequently.
Status migrainosus
This describes a severe migraine attack lasting more than 72 hours. Symptoms are persistent and debilitating, often not responding to usual treatments. This prolonged attack can significantly interfere with daily functioning.
Identifying Atypical Migraines
Diagnosing atypical migraines requires a comprehensive approach by a healthcare professional due to their varied presentations. The process begins with a detailed patient history, understanding the pattern, frequency, duration, and specific characteristics of symptoms. Providers will ask about associated features, including neurological or sensory disturbances, and their impact on daily life.
A thorough neurological examination assesses function and rules out other conditions with similar symptoms. Differential diagnosis is a key step, systematically ruling out other medical conditions like stroke, seizures, or inner ear disorders that can share symptoms. This careful exclusion ensures an accurate diagnosis and appropriate management.