A migraine is a type of headache that affects more than 12% of the population. Many people experience migraine pain every once in a while, which is known as an episodic migraine. However, about 1% of the world’s population experiences chronic migraines, with frequent episodes that occur for months on end. 

Many people think that “migraine” refers to a type of intense headache. However, there are actually several different types of migraines, which can present in different ways, depending on the person. Knowing which type of migraine affects someone is important because it will determine the treatment and whether a trip to the emergency department is in order.

This guide from HealthTap breaks down the different types of migraine headaches, potential causes, the acute treatment of migraine, and prevention of future headache pain.

What is a migraine?

Because the term “migraine” is so common, many people think it is one condition that affects everyone the same way. However, a migraine headache is actually a label given to various symptoms, such as throbbing pain, sensitivity to light and sound, and nausea and vomiting. 

During a migraine, nerve cells trigger the trigeminal nerve. The body then releases serotonin and calcitonin gene-related peptide (CGRP), causing the brain’s lining to swell. This swelling causes inflammation in the neurotransmitters, leading to pain.

Which symptoms someone experiences, when, and how, often depends on the individual. Doctors diagnose migraines based on the patient’s symptoms after ruling out other potential causes, such as a stroke, tumor, or another neurological condition. 

Migraine headaches affect 12% of the population. Risk factors such as cardiovascular disease, psychiatric conditions like depression and anxiety, and sleep disorders can make migraines more likely. Migraines are the sixth most disabling condition in the world, according to research. 

What causes migraines?

Doctors don’t have a full understanding of what exactly causes migraines. Some possible explanations are that people with migraines have dysfunctional electrical activity in the brain, which changes blood flow in the brain and puts painful pressure on surrounding brain structures. 

Of course, this does not explain why people with migraines have that dysfunction in the first place, but it is likely a combination of genetics and lifestyle factors. Those with a family history of migraines are up to 60% more likely to have the condition. 

Contributing lifestyle factors can vary for each migraine sufferer. Some possible culprits include hormonal imbalances (which are closely linked to sleep, diet, and stress levels), food sensitivities, smoking, and vitamin or mineral deficiencies. 

External stressors often trigger migraines, and can include:

• Psychological stress.

• Changes in sleep pattern.

• Changes in weather.

• Excessive caffeine intake.

• Foods like aged cheeses or chocolate.

• Alcohol, especially red wine.

• Bright lights. 

• Hormonal changes (such as those caused by the menstrual cycle).

Migraines are also more common in developed nations. This may be because citizens of more developed nations tend to experience higher rates of sleep deprivation, psychological stress, and poor dietary choices. 

What are the symptoms of a migraine? 

A migraine consists of three stages with distinct signs and symptoms. These stages include the premonitory phase (which happens before the migraine), the migraine attack, and the postdrome (which happens after the migraine). Migraine symptoms depend on the stage. 

The premonitory phase is usually set off with a trigger, and can start as early as several days before the actual migraine attack. The symptoms can include:

• Food cravings or aversions.

• Digestive problems, like stomach pain. 

• Stiff muscles (especially in the upper body).

• Visual changes, such as flickering lights.

• Sensitivity to light or sound.

• Mood changes.

• Physical fatigue.

A migraine attack follows the premonitory phase. The symptoms can vary from person to person, but most migraine attacks last between four to 72 hours, and are described as moderate to severe. In some cases, the pain can be so intense that it’s confused as a stroke. 

In migraine attacks, the pain is usually throbbing and on one side of the head. However, in rare cases, the attack may not cause any pain at all and instead lead to other symptoms, such as extreme dizziness and brain fog. 

After the migraine attack subsides, the postdrome phase sets in. Many migraine sufferers describe it as a “hangover” feeling, with symptoms such as physical and mental fatigue, poor cognitive function, and a depressed mood. This phase can last several days. 

What are the different types of migraines? 

Migraine with aura

An aura is a series of symptoms that serve as “warning” of an impending migraine headache. The symptoms are usually visual, such as flashing lights or black dots. An aura can start 30 minutes before the migraine, and sometimes continue through the migraine, too. About a third of all migraine sufferers experience an aura. 

Migraine without aura (common migraine)

Migraine without aura is the most common type of migraine. It has the same symptoms of a migraine with aura, like throbbing pain on one side of the head, sensitivity to light and sound, and nausea and vomiting. However, there are no warning signs that occur right before the migraine attack.

Hemiplegic migraine

Hemiplegia is a condition that affects one side of the body. In a hemiplegic migraine, the symptoms can be so severe that they cause extreme muscle weakness on one side, which can cause temporary paralysis. A hemiplegic migraine is also extremely painful, which is why many people confuse it with a stroke.

Retinal migraine

This type of migraine generally causes visual disturbances that affect one eye. Sometimes, it can cause temporary blindness, which can last up to 20 minutes. The changes usually happen before the actual migraine attack sets in.

What makes a retinal migraine different from a migraine with aura is that it only affects one eye. On the other hand, an aura causes visual disturbances in both eyes. 

Chronic migraine

Some migraines can be infrequent, happening once in a while. However, migraines can be a daily reality for others. Those who have migraines 15 or more times per month have chronic migraines. 

The pain can vary in severity depending on which day the migraine happens. Some people dealing with migraines may take pain relievers to manage the pain. Unfortunately, this can actually increase the number of migraines that occur every month, a condition known as medication overuse headache. 

Migraine aura without headache

Also known as acephalgic migraine, this type of migraine does not usually present with any pain. However, it tends to have symptoms of an intense aura, such as visual changes, sensitivity to light and sound, dizziness, and nausea and vomiting. 

This migraine type usually has the same triggers as a regular migraine, but the treatment options may be different because it doesn’t involve pain. 

How can you treat migraines?

Patients can usually take common migraine medication as soon as an individual feels their migraine coming on. Beta-blockers like propranolol, calcium channel blockers, and some tricyclic antidepressants like amitriptyline can even help ease the pain of a migraine. There are even intravenous magnesium sulfate treatments and gepants for migraine treatment. 

The following are other treatment options for acute migraine attacks. 

• Pain relievers
  Some popular over-the-counter options include NSAIDS like ibuprofen, aspirin, or naproxen, or painkillers like acetaminophen. However, general guidelines recommend against using these often, as they may cause rebound headaches. 

• Triptans
  These medications, including sumatriptan, rizatriptan, eletriptan, naratriptan, and zolmitriptan, work by shrinking blood vessels, which can take pressure off the surrounding nerves and relieve some of the pain. They are available as pills, intramuscular shots, or nasal sprays. Doctors generally do not recommend these medications for patients with a history of cardiovascular disease because they affect the vascular system. 

• Dihydroergotamine
  Similar to triptans, this type of medication works by tightening blood vessels in the brain. It is available as a nasal spray or intramuscular injection. Individuals with a history of stroke, heart attack, or hypertension should avoid this medication, according to general guidelines.

• Lasmiditan:
  The FDA recently approved this drug for migraines with or without aura. If patients take this medication at the first sign of a migraine, it may work to stop the process that can lead to a full-blown migraine. It also doesn’t cause blood vessel constriction, which may make it safer for those with a history of cardiovascular disorders. 

• Opioid medications
  These medications are pain relievers that act on the brain and body’s opioid receptors. It blocks pain signals from getting through to the brain while boosting feelings of pleasure. Doctors suggest that patients should only use opioids in cases of severe migraine attacks when other methods of pain relief don’t work, because these medications have high addiction risk. 

• Anti-nausea medication (antiemetics)
  People with migraines commonly deal with nausea and vomiting. Anti-nausea supplements or drugs like metoclopramide or prochlorperazine can provide relief from these symptoms. 

How can you prevent migraines?

There is no one-size-fits-all approach to preventing migraines. Preventive treatment requires getting to the root cause, which varies from person to person. Instead, it is important for the patient to work with their doctor to examine the potential causes of their migraine headache. 

​The first place to start migraine prevention is by examining all the factors that contribute to a healthy lifestyle. It’s important to optimize sleep hygiene. Many migraine sufferers have disrupted sleep patterns, and a poor night’s sleep is one of the most common migraine triggers. Focusing on getting enough high-quality sleep in a dark, cool room can be an effective first step towards migraine relief. 

Smoking can increase blood pressure, which increases the risk of migraine. Aside from that, smoking can increase a person’s risk of stroke or heart attack, which is already higher for those with migraines.

Other lifestyle factors to address include diet, exercise, and stress. A deficiency in any of these — such as nutrient deficiencies, lack of physical activity, or dealing with chronic stress — can lead to migraines. Following a healthy and balanced lifestyle can help prevent or at least reduce future migraine attacks. 

Managing migraines with HealthTap 

There are several types of migraine headaches, from occasional migraines to those that are chronic. These include migraine with aura, common migraine, hemiplegic migraine, retinal migraine, and aura without headache. If migraines occur 15 or more times per month, they are considered chronic migraines. 

If you suffer from a severe headache you believe could be a migraine, it’s important to meet with a healthcare provider to figure out the best treatment options for you. 

HealthTap can connect you to a low-cost doctor through our virtual platform — so you never have to leave home. 

Make an appointment today to get the relief you need and deserve.