OT: The Different Types of Migraine Headache...

Discussion in 'Fibromyalgia Main Forum' started by kjfms, Nov 13, 2006.

  1. kjfms

    kjfms Member

    Since so many of us have migraine I want to post the different type and classifications for those interested.

    This is from Merck Medicus Modules and the Web Site is posted at the end of this article.

    Classification of Migraine

    Migraine headaches are classified according to their clinical features, as well as according to current concepts of pathophysiology.

    Patients who have migraine without aura generally have normal cerebral blood flow and do not report focal neurologic symptoms.

    In those who have migraine with aura, changes in regional cerebral blood flow can be demonstrated and neurologic symptoms originating in the brain or brain stem are reported.

    The current IHS classification system recognizes several subtypes of migraine with aura and several other specific types of migraine (see table below).

    IHS Classification of Migraine
    1. Migraine

    1.1 Migraine without aura

    1.2 Migraine with aura
    1.2.1 Migraine with typical aura
    1.2.2 Migraine with prolonged aura
    1.2.3 Familial hemiplegic migraine
    1.2.4 Basilar migraine
    1.2.5 Migraine aura without headache
    1.2.6 Migraine with acute onset aura

    1.3 Ophthalmoplegic migraine

    1.4 Retinal migraine

    1.5 Childhood periodic syndrome that may be precursors to or associated with migraine
    1.5.1 Benign paroxysmal vertigo of childhood
    1.5.2 Alternating hemiplegia of childhood

    1.6 Complications of migraine
    1.6.1 Status migrainosus
    1.6.2 Migrainous infarction

    1.7 Migranous disorders not fulfilling above criteria

    Migraine without aura

    Migraine without aura is an idiopathic recurring headache disorder that manifests in the form of attacks that last 4-72 hours.

    Typically, the headaches are unilateral, have a pulsating quality, and are moderate to severe in intensity.

    These headaches are aggravated by routine physical activity and are associated with nausea or vomiting, photophobia, and phonophobia.

    Migraine with aura

    Migraine with aura is also an idiopathic recurring disorder that manifests in some women as migraine without aura but is also accompanied by transient neurologic symptoms.

    Aura symptoms usually develop gradually, over 5-20 minutes, and last less than 60 minutes. Headache, nausea, or photophobia usually follow neurologic aura symptoms directly or after a free interval of less than 1 hour.

    The headache usually lasts 4-72 hours, but rarely will be completely absent (migraine aura without headache).

    The six (6) subtypes of migraine with aura are:

    Migraine with typical aura:
    migraine characterized by an aura consisting of unilateral visual disturbances, sensory disturbances, and muscular weakness or partial paralysis.

    The aura develops gradually, lasts less than 1 hour, and is completely reversible.

    Migraine with prolonged aura:
    migraine accompanied by an aura that lasts more than1 hour but less than 1 week.

    Diagnostic studies must fail to show evidence of neurologic disease.

    Familial hemiplegic migraine:

    a rare migrainous disorder that runs in families and involves an aura characterized by muscular weakness or partial paralysis on one side of the body.

    Basilar migraine:
    an uncommon migrainous disorder in which the aura clearly originates from the brain stem or from both occipital lobes of the brain.

    It may be accompanied by dramatic neurologic events, such as total blindness, followed by vertigo, incoordination, difficulty speaking or concentrating, and other signs and symptoms.

    Migraine aura without headache:
    a migrainous aura that is not associated with a headache.

    Migraine with acute onset aura:
    a migraine headache in which the aura develops fully in less than 5 minutes.

    Other types of migraine

    Ophthalmoplegic migraine:
    An extremely rare condition that may affect the ocular nerves, is characterized by drooping of the eyelids and dysfunction of the extraocular muscles that results in double vision.

    Another rare form of migraine is Retinal Migraine, in which inadequate blood supply to the retina results in a scotoma or transient blindness affecting one eye.

    This differs from the visual disturbances usually associated with migraine aura in that only one eye is affected in retinal migraine compared with the visual disturbances being perceived in both eyes in migraine with visual aura.

    Many recurrent disorders that occur in childhood have migraine-like features and may represent precursors to typical migraine syndromes or alternative forms of migraine.

    Although not all of these disorders have been classified, the IHS classification of headache disorders lists two such syndromes along with diagnostic criteria.

    Benign paroxysmal vertigo of childhood is characterized by recurrent attacks of vertigo, which is an illusory sense that either the environment or one’s own body is moving or rotating.

    Alternating hemiplegia of childhood is a disease that occurs primarily in infants and is characterized by muscle weakness or partial paralysis on one side of the body.

    Different sides of the body can be affected during different attacks, and each attack is accompanied by other neurologic phenomena, some of which are reminiscent of epilepsy.

    Complications of migraine include status migrainosus, in which the headache phase of a migraine attack lasts more than 72 hours despite treatment.

    Another very rare complication of migraine is migrainous infarction, in which one or more aura symptoms is not reversible within 7 days of onset or diagnostic studies indicate that an associated area of the brain has had a stroke due to inadequate blood supply.

    Stages of a migraine attack

    Patients with migraine typically experience moderate to severe, unilateral headaches associated with nausea or vomiting, photophobia, and phonophobia.

    In Phase I, about 20% of patients experience prodromal symptoms such as mood changes, hypoactivity or hyperactivity, food cravings, fluid retention, and hypersensitivity to light, sound, or smell.

    Phase II consists of the migraine aura, which includes various transient neurologic (usually visual) symptoms that last 5-60 minutes.

    Symptoms and Signs during Phases of "Complete" Migraine Attacks with Aura

    Phase III is the headache phase, whereas Phase IV represents the resolution phase, during which the intensity of migraine symptoms gradually abates.

    Many migraine headaches resolve while a patient sleeps.

    The last phase of a migraine, Phase V, is the recovery period, or postdrome, during which the headache has resolved, but the patient feels tired and has a limited tolerance for food.

    If fluid retention characterized the prodromal period (Phase 1), a period of diuresis may occur.


    Thanks for reading,

    Karen :)

    [This Message was Edited on 11/13/2006]
  2. charlenef

    charlenef New Member

    i would have aura but no headache when i turned around 16 i started to get both im lucky like that.lol charlene
  3. beachwalkerbill

    beachwalkerbill New Member

    Great post Karen
  4. kjfms

    kjfms Member

    Thanks for reading and I am sorry for anyone that suffers from migraines.

    I have had migraines since I was 14 they run in my family -- grandmother had them.

    Mine changed several years from classic with vomiting (several a month) to more weather related with nausea no vomiting daily.

    With these "new" migraines as I call them even though I have had them for about 4-5 years now I have an incredible heightened sense of smell.

    I know when a storm is coming usually about 2 days in advance. I have tracers like an acid trip -- so I told ;)

    I argued with the neurologist when he told me these were migraines because I was convinced they were sinus related and hey I'd had migraines most of my life and I knew what a migraine was...

    I don't know which is worse the "classic" I used to have or these "new" I have had for a while now -- I wish I had neither.

    Anyway Topmax helps in the severity -- a little.

    Thanks again,

    Karen :)
  5. julieisfree05

    julieisfree05 New Member

    When I was diagnosed with this in 1988, CDH was not a classification yet.

    My neurologist had to call it "variant migraine". It meant that I got a migraine every day (one-sided, nausea, light/noise sensitivity, but no "aura").

    There is a GREAT book that I recently read about one woman's experience with CDH. (She also speaks about fatigue, FM and other "chronic pain").

    It's called:

    All In My Head (A Memoir): An Epic Quest To Cure An Unrelenting, Totally Unreasonable, And Only Slightly Enlightening Headache

    by: Paula Kamen

    It's honest, funny, and brutally accurate about trying EVERYTHING to get rid of CDH.

    I highly recommend it!

    - julie (is free!)
  6. victoria

    victoria New Member

    "Benign paroxysmal vertigo of childhood is characterized by recurrent attacks of vertigo, which is an illusory sense that either the environment or one’s own body is moving or rotating."

    Thanks, never read that classification before; I remember experiencing that 3 or 4 times before I turned 12... remember awakening in AM, and feeling fine UNTIL I moved my head, then everything rotated and it hurt like crazy...

    I'd have to lay as still as a rock for about 5-6 hours until it went away... nothing helped...

    Migraines as an adult were triggered by chemical exposure tho. Stupid me as a teenager would oil paint in my bedroom, with windows and hall door shut in wintertime... altho I only had one migraine then... but later had one or two being exposed to similar substances via fumes.


    [This Message was Edited on 11/20/2006]
  7. victoria

    victoria New Member

    fascinating study done in 2004:

    Sinuses Giving You a Headache? It's Probably a Migraine.
    June 10, 2004

    If you've tried various over-the-counter sinus medications to relieve your sinus headaches to no avail, there may be a good reason: chances are you don't have a sinus headache at all. Nearly 9 in 10 people with sinus headache symptoms likely are suffering from Migraines, suggests a study being presented at the 46th Annual Scientific Meeting of the American Headache Society (AHS).


    • If you think you have a sinus headache, chances are it's actually a Migraine, suggests a Mayo Clinic Scottsdale study.

    • Pain or pressure on both sides of the face, a runny nose and red or puffy eyes are likely symptoms of Migraine.

    • The most effective Migraine medications are triptans. Unless there are signs of a sinus infection, antibiotics should not be prescribed.

    • More than 32 million Americans suffer from Migraines.¹

    "It's not surprising that people are convinced they have sinus headaches, because they often have nasal congestion, pressure or pain in the forehead or just below the eyes, and red or puffy eyes," said lead investigator Eric Eross, D.O., associate consultant in neurology at the Mayo Clinic in Scottsdale, Ariz. "It's guilt by association. Much of the pain or pressure is in the face, on both sides, so it doesn't occur to them that this might be a Migraine."

    Because they wrongly believe their Migraines are sinus headaches, some sufferers may be taking too many over-the-counter sinus medications inappropriately.

    A Migraine can inflame one of the nerves in the head that has branches in the face, and as a result, the pain may be felt near the sinuses, which are air pockets between bone in the lower forehead, cheeks and behind the nose.

    If you get what you think are sinus headaches, it's important to be evaluated by a headache specialist, said Dr. Eross. On average, each of the 100 patients in the study had seen more than four physicians for their headaches and had gone an average of 25 years without receiving the correct diagnosis - or significant relief.

    "It was hard to convince some of them that they actually suffered from Migraine headaches," said Dr. Eross. "Many were shocked."

    About 12 percent of the U.S. population - or 32 million people - suffer from Migraines.

    One of 10 people in the study knew they suffered from Migraines, but thought they had sinus headaches in addition. They actually suffer from 2 different types of Migraines, one with sinus symptoms, one without, said Dr. Eross. While many got some pain relief by using non-prescription medications, such as ibuprofen or acetaminophen, Migraine-specific medications would be much more helpful, he said.

    "Real" sinus headaches are almost always a side effect of a sinus infection, which is a very common ailment: 37 million Americans get at least one sinus infection every year, according to the American Academy of Otolaryngology - Head and Neck Surgery.

    Typical symptoms of a sinus infection are fever, swollen lymph nodes and a persistent green or yellow nasal discharge. If you don't have those symptoms and you've got the headache, you likely have Migraines, said Dr. Eross.

    Ironically, researchers believe a few of the people in the study may have acquired sinus infections as a RESULT of having a Migraine. Lengthy Migraine attacks can lead to swollen nasal membranes and closed off sinus passages, creating the perfect environment for an infection, said Dr. Eross.

    But by far the majority of people in the study did not have sinus infections, and some had unnecessarily been prescribed antibiotics.

    The study - called the Sinus Allergy & Migraine Study (SAMS) - included the first 100 people to answer an ad in the local newspaper asking for people who thought they had sinus headache. Each underwent an extensive 90-minute evaluation by researchers and some had imaging tests. Experts determined:

    * 63 percent were suffering from Migraines,
    * 23 percent had probable Migraine,
    * 9 percent had headaches that couldn't be classified,
    * 3 percent had headaches as a result of a sinus infection,
    * 1 percent had cluster headaches and
    * 1 percent had hemicrania continua, a rare type of chronic headache.

    Although the International Headache Society (IHS) doesn't list sinus headache (without an infection) as a classification of headache, the researchers suggest there actually may be such a thing, if uncommon, and called it NIRSH - noninfectious rhino-sinus headache. Researchers believe the 9 people whose headaches didn't meet any IHS classifications actually suffer from NIRSH.

    Of the 100 participants:

    * 98 percent said they had pain over their sinuses,
    * 97 percent said they had pain in the face,
    * 83 percent said the weather influenced their headaches,
    * 78 percent said their physicians had diagnosed them as having sinus headaches,
    * 76 percent said sinus medication helped,
    * 73 percent said they had a runny nose with the headaches,
    * 71 percent said their headaches varied with the seasons and
    * 67 percent said allergies affected their headaches.

    SAMS researchers also analyzed the 63 people diagnosed with Migraine. Among their findings:

    * 56 percent had nasal congestion, 37 percent had eyelid puffiness, 25 percent had a runny nose, 22 percent had red eyes, 19 percent had tearing, and 3 percent suffered from droopy eyelids.

    * 57 percent had Migraine pain first, which eventually triggered the sinus-like symptoms, while 33 percent had sinus-like symptoms FIRST, possibly triggering the Migraine.

    Headaches were triggered by weather changes for 83 percent, 73 percent said they noticed seasonal variations in their headaches,
    62 percent said their headaches were triggered by a specific allergen and
    38 percent noticed a change in altitude had an effect on their headaches.

    "This study suggests we should appreciate the role the change of seasons may play in Migraine," said Dr. Eross. "It also suggests allergies may trigger Migraines."

    * The study participants had to wait an average of 25 years before receiving the correct diagnosis of Migraine - in most cases by SAMS investigators. Researchers calculated that the average direct cost in seeking a correct diagnosis was $2,831.06 per person, including consultations with various doctors and undergoing diagnostic tests such as sinus imaging studies.

    * Slightly more than half (51 percent) were severely affected as a result of their headaches, including missed days from school, or work, work around the house or social events - and 21 percent were moderately affected, as determined by a Migraine disability score.

    * The majority (95 percent) were taking some sort of medication: 33 percent were taking non-steroidal anti-inflammatories (NSAIDS) such as ibuprofen and naproxen; 25 percent were taking acetaminophen; 21 percent were taking other non-prescription pain relievers, 21 percent were taking non-prescription sinus medications (antihistamines) and 9.5 percent were taking triptans (Imitrex/sumatriptan, Maxalt/rizatriptan, etc.), which are the most effective Migraine-specific prescription medications. When asked how beneficial the medications were, the triptans came out on top, far ahead of the next most helpful medicine, antihistamines.

    "We determined that 92 percent of these people were candidates for triptans, but only 12 percent were using them," said Dr. Eross. "As headache specialists, we need to do a better job at educating patients and primary care physicians about the sinus-symptom phenomenon."

    Dr. Eross's SAMS co-investigators are D.W. Dodick, and J.P. Gladstone.

    The American Headache Society (AHS), founded in 1959 as the American Association for the Study of Headache, is based in Mt. Royal, N.J. AHS is a professional organization for those interested in the study and management of headache and face pain. For more information, visit the AHS Web site at http://www.ahsnet.org/.

    To fill the need for patient education, AHS established the American Council for Headache Education (ACHE), a non-profit patient-physician organization for the advancement of the treatment and management of headache and the encouragement of more constructive social attitudes toward the disease. Individuals who would like more information about headache, who would like a referral to a specialist who treats headache or who would like information on support groups can call (800) 255-ACHE at 19 Mantua Road, Mt. Royal, N.J. 08061, or visit the ACHE Web site at http://www.achenet.org/.

    ? According to the World Health Organization, 6% of men and 18% of women have Migraine disease. Applying those percentages to the official United States Census of 2000, determines that there are more than 32 million Migraineurs in the United States.

    from an 'about' site:

    * One out of ten people have Migraine disease.
    * Migraine disease is more common than asthma and diabetes combined.
    * 90% of Migraineurs report some disability cause by their attacks according to the American Migraine Study II.
    * The World Health Organization ranks Migraine among the world's most disabling illnesses.
    * Triptans are effective for approximately 80% of Migraineurs, BUT
    * triptans are prescribed for only 20% of Migraineurs, SO
    * many Migraineurs haven't had the opportunity to try triptans.


    OK I could have migraines... but still haven't seen aching teeth listed... still waiting to see if guai helps... if it doesn't I'll probably try more of the triptin meds (trie dimitrex but it made it worse).... or just skip the meds and work on biofeedback which helps a very high percentage of migraines... and would probably help me regardless of what it is...

    Hope some find this interesting, I did...

    all the best,

  8. victoria

    victoria New Member

    I cannot believe I have just tonight seen this term for the very very first time; no ENT or dentist or infectious disease doctor, all of whom I have been to repeatedly, has ever mentioned this possibility:

    periodic migrainous neuralgia (PMN)

    Anyone else ever heard of that term before???

    Here's a study, dating way back... to date so far all I've seen mentioned for relief is surgery on the trigeminal nerve if migraine medication doesn't help.

    Oral Surg Oral Med Oral Pathol. 1978 Oct;46(4):511-6.
    Periodic migrainous neuralgia: a cause of dental pain.

    * Brooke RI.

    The clinical findings in thirty-five cases of periodic migrainous neuralgia (PMN) are given. Typical case histories are used to illustrate the fact that the condition may mimic dental pain. The nomenclature and association of the condition with migraine are briefly discussed, and a plea is made that the condition always be considered in cases of facial pain, when other clinical features of the disease are present, in order to save needless loss of teeth and delay in treatment.

    PMID: 280846 [PubMed - indexed for MEDLINE]


    Luckily no dentist ever thought pulling a tooth would get rid of the pain or I'd be missing all my top teeth ultimately... but never mentioned the symptom as possibly being migraine.

    Well, regardless of whether I'm suffering from sinusitis from fungal or any other origins, OR migraine, OR both --

    I am buying a temperature training biofeedback unit in the next few days... works on all types of headaches quite well as I was just reminded...

    by my dear husband, who was a clinical psychologist (now retired/disabled) who used biofeedback extensively; he found all headaches responded at least to some degree to temperature training (making the hands warmer), including allergy headaches... my hands are quite often cold regardless of having a headache or not.

    ("can I please plead brain fog, dear?")

    all the best,

    all the best,

    [This Message was Edited on 11/20/2006]
  9. b~kay~b

    b~kay~b New Member

    Great stuff gonna check it out i was given topamx for pain didnt help that none but one side effect i appreciated, it helped the migraines. migraines run in my family too, along with other stuff. we use to wonder if its all connected. now im convinced i was epoleptic-outgrew by age 9, mom had epolepsy-she became seizure free, sister has anxiety and migraines and my mom has lots and lots of my symptoms (she doesnt have insurance so she wont go to a doc) so i believe the hereditary thing. gramma had alzheimer and tremors, mom has tremors, not as bad as i do, she says but her memory symptoms are there, train of thought etc etc i really think its all linked.
  10. victoria

    victoria New Member


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