Migraine Without Aura


Migraines are typically classified based on the sufferer experiencing an early symptom, called an aura. Currently, there are two major types of migraines: migraines with aura (MWA) and migraines without aura (MWOA). Majority of migraineurs suffer from migraines without aura, which means they do not experience the sensory or visual warning signs. According to recent migraine statistics, migraine auras happen to only 20 percent of people who experience migraines.


The common symptoms experienced during a migraine without aura are:

  • Phonophobia
  • Pulsing pain
  • Throbbing pain
  • Sensitivity to light
  • Sensitivity to sound
  • Nausea and/or vomiting
  • Pain on one side of head
  • Pain/discomfort increases with physical activities


Diagnostic criteria from IHS:

A. At least five migraine attacks that fulfill criteria B through D

B. Each migraine attack, untreated or unsuccessfully treated, lasts from four to 72 hours

C. Head pain that has at least two of the following

  • Pain on one side of the head, unilateral pain
  • Pulsating or throbbing pain
  • Moderate to severe head pain
  • Triggered by routine physical activity, such as walking or climbing stairs

D. During head pain, at least one of the following:

  • Nausea and/or vomiting
  • Light sensitivity
  • Sound sensitivity

E. Not due to any other disorder

Diagnosing migraine with aura, much like any type of migraine, is very difficult due to the wide range of symptoms. To effectively diagnose migraine without aura, doctors must have the most up to date information regarding your migraine attacks. One way to help your doctor in the diagnoses process is to keep a migraine journal of all your symptoms. This will help your physician rule out any other causes as well as have a much better picture of a beneficial treatment plan.


First, if there are underlying causes for your migraines, your doctor will identify those issues and recommend appropriate treatment. Once all other causes are ruled out, a path of relieving symptoms and preventing future attacks is taken.

To begin treatment, your doctor may recommend the following actions to help relieve symptoms:

  • Seclude yourself to a quiet, dark room.
  • Place cold compresses on the painful areas.
  • Take pain-relieving medications such as Tylenol (acetaminophen) or aspirin
  • Take non-steroidal anti-inflammatory medication (called NSAIDS) such as ibuprofen or naproxen

In addition to the above treatment, your doctor may suggest additional ways to help prevent additional migraines. These steps might include taking specific medications along with avoiding any triggers that cause migraines.


Many medications which may have been developed for other purposes are used to successfully prevent migraines. These include:

  • Antidepressants such as Elavil (amitriptyline) and Pamelor (nortriptyline)
  • Ergot derivatives such as Sansert (methysergide)
  • Beta-blockers such as Tenormin (atenolol), Inderal (propranolol), and Blocadren (timolol)
  • Antihistamines such as Periactin (cyproheptadine)


Use the collected information from your migraine diary to determine if any of these foods, medications or other triggers might be causing your migraines.


  • chocolate
  • cheese
  • red wine or other alcohol
  • citrus fruits
  • avocados
  • bananas
  • raisins
  • plums
  • artificial sweeteners
  • food preservatives, such as nitrates, nitrites, and monosodium glutamate (MSG)
  • ice cream or other cold foods


  • Estrogen
  • Reserpine
  • Nitroglycerine
  • Ratidine
  • Cimetidine


  • Too much/little sleep
  • Stress
  • Depression
  • Anxiety
  • Missing meals
  • Menstruation
  • Flickering/fluorescent lights
  • Changes in pressure/altitude

Migraine With Aura


A migraine with aura, previously referred to as a classic migraine, is a migraine that’s preceded or accompanied by visual, auditory, and other sensory warning signs that occur before or at the onset of migraine headache. These warning signs are also called a prodrome and usually develop gradually over 5-20 minutes and last for less than one hour. The pain usually occurs in the front portion of the head on one or both sides of the temples. The sensation may bring on a throbbing sensation and can last from four to 72 hours.


Symptoms of a migraine with aura may include any of these:

  • Vomiting
  • Nausea
  • Dark circles under the eyes
  • Yawning
  • Irritability
  • Low blood pressure
  • Sensitivity to light, sounds, or motion

A migraine with aura can come with other symptoms, which typically begin 30 minutes or less before the headache does. This is referred to as a prodrome. The prodrome or aura may last for five to 20 minutes and can continue even after the headache retreats. Symptoms of aura include:

  • Weakness
  • Blind Spots
  • Seeing zigzag patterns
  • Sensation of prickling skin
  • Weakness
  • Hallucinations
  • Blindness in vision field


Before physicians will select your treatment, a full exam that may include neurological exams will be performed. In addition to these tests and physical evaluations, these questions may be asked:

  • Do you suffer from any allergies?
  • Do any family members have migraines or other headache types?
  • Do you experience high levels of stress?
  • Are you currently using any birth control medications that can cause migraines?

Other tests may also be required to ensure your migraines are not being caused by other factors. These tests may include:

  • Image scans such as X-ray, CT scan, or MRI
  • Blood tests


First, if there are underlying causes for your migraines, your doctor will identify those issues and recommend appropriate treatment. Once all other causes are ruled out, a path of relieving symptoms and preventing future attacks is taken.

To begin treatment, your doctor may recommend the following actions to help relieve symptoms:
Seclude yourself to a quiet, dark room. Place cold compresses on the painful areas. Take pain-relieving medications such as Tylenol (acetaminophen) or aspirin Take non-steroidal anti-inflammatory medication (called NSAIDS) such as ibuprofen or naproxen

In addition to the above treatment, your doctor may suggest additional ways to help prevent additional migraines. These steps might include taking specific medications along with avoiding any triggers that cause migraines.


Menstrual Migraines


While many women do report their menstruation as a migraine trigger, there is a specific condition known as menstrual migraine. Menstrual migraines are most likely to occur in the two days leading up to a period and the first three days of a period. There is no reported aura with this type of migraine, however, it can often last much longer than other types. The two most accepted theories on the cause of menstrual migraines are:

  • Withdrawal of estrogen as part of the normal menstrual cycle
  • Normal release of prostaglandin during the first 48 hours of menstruation

Currently, there are no tests to confirm the diagnosis of menstrual migraines. The only way to accurately tell if you are suffering from menstrual migraines is to keep a migraine diary for at least 6 months, recording all migraine episodes and the days you menstruate. By doing this, you will be able to identify non-hormonal triggers that you may be able to avoid to prevent further episodes.


  • Menstrual migraines most often occur two days before their period
  • Migraine attacks in women usually begin with their first menstrual period, which is also called menarche
  • Many times migraines improve in the last six months of pregnancy
  • Use of oral contraceptives may change the frequency and severity of migraines
  • Often migraines worsen in the postpartum period, immediately after a woman has given birth
  • For many women, the migraines improve after menopause
  • Typically, the first migraine with aura attack occurs between the ages of 12 and 13
  • The first migraine without aura attack usually occurs between the ages of 14 and 17


There are numerous treatment options for menstrual migraines, although none of these options are licensed to specifically treat them.
If you experience migraines and heavy periods, taking an anti-inflammatory painkiller such as mefenamic acid could help relieve your symptoms. Mefenamic acid is an effective migraine preventative and can be started 2 to 3 days before the expected start of your period. Naproxen can also be an effective treatment when taken once or twice daily around the time of menstruation. Oestrogen supplements are also commonly used to relieve migraine symptoms, but remember to discuss using estrogen with your doctor before using. Increasing your falling estrogen levels just before and during your period might help if your migraine occurs regularly before your period. Oestrogen can be taken in several forms such as skin patches or gel. If your periods are irregular, your physician may suggest other ways to maintain your estrogen levels such as an oral contraceptive pill.


Ocular Migraine


Ocular migraine, also known as retinal migraine, a visual migraine, or ophthalmic migraine is a known retinal disease that often occurs with a migraine headache and traditionally affects only one eye. It is caused by an infarct or vascular spasm in or behind the affected eye.


During some ocular migraine episodes, vision loss may occur with no headache. On other occasions, a throbbing headache may come on the same side of the head as the visual loss occurs. The visual loss tends to affect the entire monocular visual field of one eye, but not both eyes. Typically, after each ocular migraine episode, normal vision returns.

People who experience ocular migraines often complain of the following symptoms:

  • Seeing flashing lights
  • Blind spots in the visual field
  • Temporary loss of vision
  • Seeing odd patterns such as lines of zigzags
  • Nausea and/or vomiting
  • Increased sensitivity to light or sound


Diagnostic criteria from IHS:

A. At least 2 attacks fulfilling criteria B and C
B. Fully reversible monocular positive and/or negative visual phenomena (eg, scintillations, scotomata or blindness) confirmed by examination during an attack or (after proper instruction) by the patient’s drawing of a monocular field defect during an attack
C. Headache fulfilling criteria B-D for 1.1 Migraine without aura begins during the visual symptoms or follows them within 60 minutes
D. Normal ophthalmological examination between attacks
E. Not attributed to another disorder

The factors that help doctors determine if you have ocular migraines or a different type of headache are the monocular visual disturbances that you experience. The visual disturbances that occur typically take place in only one eye and may cause temporary vision loss or even blindness for a set period of time. However, before diagnosing an ocular migraine, a medical exam is performed to rule out any unknown medical conditions, such as stroke, pituitary tumor, blood clots or detached retina.


When you are suffering from ocular migraines, you may worry about migraine relief options that are available. For mild cases of ocular migraines or when you have limited pain, taking over-the-counter non-steroidal anti-inflammatory medications, like Aspirin, may be appropriate. The medication is designed to help relieve the pain and discomfort of headaches, which allow you to move forward with your activities.

Although an over-the-counter medication may be appropriate for mild symptoms, it is usually best to seek medical attention if your headaches are moderate to severe. When your migraine symptoms are interfering with your daily activities, it is important to seek the advice of a medical doctor.


Hemiplegic Migraine


Hemiplegic migraine attacks are a highly uncommon subtype of migraines with aura and can be broken down into two variations: Familial Hemiplegic Migraine (FHM) and Sporadic Hemiplegic Migraine (SHM). FHM and SHM share the same symptoms, which can vary among different Migraineurs with the difference between the two being that FHM can be traced back to family history and mutations of specific genes.

Though few people ever experience one of these migraine episodes, those who do typically suffer from a severely debilitating migraine symptom that can last for several days. For hemiplegic migraineurs, it is the aura phase that is so incapacitating. The term hemiplegic itself refers to paralysis on only half of the body. Hemiplegic Migraines can be broken down


Symptoms of FHM and SHM:

  • Nausea and/or vomiting
  • Prolonged aura
  • Paralysis on one side of the body)
  • Fever
  • Symptoms of meningitis without the actual illness
  • Confusion
  • Coma

*Loss of muscle coordination

  • Phonophobia
  • Photophobia


If you experience any symptoms that resemble a hemiplegic migraine, it’s recommended to see your doctor for a full evaluation. This is a serious form of migraines and many of its symptoms are also signs of a possible stroke. Tests to look for signs of a stroke may include a CT scan or head MRI. An exam may also include tests of the heart and blood vessels in your neck. These will evaluate whether your symptoms may be caused by blood clots forming in the heart or blood vessels in the neck.

Genetic testing is available for hemiplegic migraines. If you have a family member with similar symptoms, you may be diagnosed with “familial” hemiplegic migraines. That means it runs in your family, and you most likely could pass it on to your children. If you don’t test positive, your condition is referred to as a sporadic hemiplegic migraine.


The complexities of FHM and SHM make them difficult for doctors to treat. Because hemiplegic migraines are simply an expression of an underlying neurological disorder, researchers are tasked with learning how to not only reduce migraine frequency but also to manage the severe symptoms of hemiplegic migraines. Non-steroidal anti-inflammatory drugs, antiemetics, and narcotic analgesics are most frequently used for pain relief, and calcium channel blockers are used to prevent hemiplegic migraine episodes.

Tension Headaches


Tension headaches are the most common type of primary headaches with pain radiating from the lower back of the head, neck, eyes and other muscle groups in the body. Tension headaches account for nearly 90% of all headaches with 3% of the population suffering from chronic tension-type headaches. However, despite the high occurrence in the population, it’s the least studied of the primary headache disorders.


Tension headaches fall into three categories: infrequent episodic, frequent episodic and chronic. Infrequent episodic tension headaches occur once a month. Frequent episodic tension headaches occur more than once, but fewer than 15 times a month for three or more months. Chronic tension headaches occur 15 days or more a month that last for at least 6 months and may bring slight nausea. Tension-type headaches can last anywhere from minutes to days, months or years. A typical tension headache usually lasts between four and six hours.

Common tension headache symptoms are:

  • Dull head pain
  • Pressure around the forehead
  • Tenderness around the forehead and scalp


While there is no easy way to diagnose a tension headache, a successful diagnosis can be achieved by reviewing personal and family medical history, studying current symptoms and receiving a proper medical examination. A tension-type headache can then be diagnosed by ruling out other causes.


If the number of tension headache episodes increase into the frequent or chronic range, preventive treatment can be recommended.

Treatment for tension headache episodes include:

  • Ibuprofen
  • Aspirin (for adults)
  • Acetaminophen
  • Acetaminophen/caffeine combinations
  • Muscle relaxants

The most commonly used preventive medications are:

  • Muscle relaxants
  • Botox
  • Antidepressants such as amitriptyline

Other methods that compliment the above treatment methods are often employed to treat tension headaches, including:

  • Biofeedback
  • Acupuncture
  • Physical therapy
  • Massage therapy

Cluster Headaches


Cluster headaches are recurrent headaches that take place over a specific period of time. During an episode, a person experiencing a cluster headache may experience one to three of these piercing headaches per day, although it is not unheard of to experience as many as eight of these headaches throughout the day.

Cluster periods can last anywhere between two weeks and three months. Many people experience them at the same time of the year each year. Many report the headaches go away completely for months, or even years, only to one day return out of the blue.

What is unique about cluster headaches is that they often wake sufferers from a deep sleep due to the pain of these headaches. This usually happens about one to two hours into the sleep cycle and is often much more painful than a daytime attack.

Cluster headaches most commonly occur in men under the age of 30. However, it is not unheard of for children to be diagnosed with this condition. Additionally, a growing number of women have been diagnosed with cluster headaches in recent years though men continue to be diagnosed as much as six times more often than women are.


Cluster headache symptoms and signs often come on rapidly and may vary slightly from person to person. They include:

  • Intense, continuous pain that begins in the area around the eye. This pain may radiate to other areas of the head and face, including the cheek, temple, neck, and sometimes shoulder area.
  • Pain is generally limited to one side of the head where the eye may become red and/or watery
  • Drooping eyelid on pain side
  • Constricted pupils
  • Sufferer becoming sweaty or pale in the face
  • Nose one the affected side becomes stuffy, blocked, or runny
  • Pain between 30 and 90 minutes, though they may last as little as 15 minutes or as much as three hours
  • Experience one to three headaches per day during the cluster period, though some people will experience more


Diagnostic criteria from IHS:

A. At least 5 attacks fulfilling criteria B-D
B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes if untreated
C. Headache is accompanied by at least one of the following:

  • Nasal congestion and/or rhinorrhoea
  • Eyelid oedema
  • Forehead and facial sweating
  • Miosis and/or ptosis
  • Sense of restlessness or agitation

D. Attacks have a frequency from one every other day to 8 per day
E. Not attributed to another disorder

A cluster headache diagnosis often involves a lengthy appointment with your doctor in which you discuss all your symptoms or during an actual episode or attack. MRIs and other tests or examinations are often used in the diagnosis process in an effort to rule out other potential causes of your headaches.


While there is no cure for cluster headaches, comprehensive treatment can help your symptoms. Treatment for pain relief during a cluster headache can include:

  • Oxygen: Pain relief can be achieved by breathing in 100% pure oxygen during a cluster headache. You will breathe through a plastic mask that is attached to an oxygen tank for about 15 minutes.
  • Triptans, such as sumatriptan (Imitrex)
  • Anti-inflammatory medicines such as prednisone
  • Injections of dihydroergotamine (DHE), which can stop cluster attacks within 5 minutes

Chronic Daily Headache


Chronic daily headaches (CDH), in order to be classified as chronic, must occur at least 15 days or more a month, for at least three months. Even further, to be considered primary chronic daily headaches, they must also not be the result of another condition.

Chronic daily headaches are divided into four types:

  • Chronic tension-type headache
  • New daily persistent headache
  • Chronic migraine
  • Hemicrania continua


To be diagnosed with a chronic migraine, you must have headaches—tension-type, migraine or both—for 15 days or more a month, for at least three months. You must also experience headache frequency eight or more days a month for at least three months and experience the following symptoms:

  • Pulsating, throbbing sensation
  • Moderate to severe pain
  • Pain aggravated by routine physical activity
  • Affect only one side of your head

And they cause at least one of the following:

  • Sensitivity to light and sound
  • Nausea
  • Vomiting


Chronic tension-type headaches commonly evolve from episodic tension-type headaches that last hours or may be constant.

Chronic tension-type headaches have at least two of the following characteristics:

  • Mild to moderate pain
  • Pain that feels pressing or tightening, but not pulsating
  • Aren’t aggravated by routine physical activity
  • Pain on both sides of head

In addition, they cause no more than one of the following:

  • Mild nausea
  • Sensitive to light
  • Sensitive to sound


A new daily persistent headache is a daily and unremitting headache where the pain is typically bilateral, pressing or tightening in quality and of mild to moderate intensity. There may be photophobia, phonophobia or mild nausea.

New daily persistent headaches have at least two of the following characteristics:

  • Cause mild to moderate pain
  • Hurt on both sides of your head
  • Cause pain that feels like pressing or tightening, but not pulsating
  • Aren’t aggravated by routine physical activity

In addition, they cause no more than one of the following:

  • Mild nausea
  • Sensitivity to light
  • sensitivity to sound


Hemicrania continua headaches are marked by their tendency to occur unilaterally (on one side of the head). They also:

  • Cause moderate pain but with spikes of severe pain
  • Are daily and continuous with no pain-free periods
  • May sometimes become severe with development of migraine-like symptoms
  • Respond to the prescription pain reliever indomethacin (Indocin)

Also, hemicrania continua headaches cause at least one of the following:

  • Nasal congestion or runny nose
  • Drooping of the eyelid or constriction of the pupil
  • Tearing or redness of the eye on the affected side

Chronic Migraines


Chronic Migraines are described as headaches occurring 15 or more days a month. This is also referred to as transformed migraines, which are chronic daily or near-daily. Chronic migraines, along with cluster headaches, are a subset of chronic daily headache (CDH). Chronic migraines last on average longer than four hours. Migraines affect approximately 38 million Americans, or 14% of the population, while 4% suffers from chronic migraines. Chronic migraines sufferers often suffer from depression due to the fact that they have failed personal relationships and a general sense of hopelessness due to the fact that they are unable to find a treatment option that helps.


Migraine pain attacks which appear at least 15 times in a month are considered chronic migraines. The attacks will generally include two or more of the following:

  • Pulsating, throbbing pain
  • Pain level is moderate to severe
  • Pain is made worse by activities and movement
  • Pain located unilaterally
  • Sensitivity to sound and/or light
  • Nausea and/or vomiting


Diagnostic criteria:

A. Headache (tension-type and/or migraine) on ≥15 days per month for at least 3 months
B. Occurring in a patient who has had at least five attacks fulfilling criteria for migraine without aura
C. On ≥8 days per month for at least 3 months, headache has fulfilled criteria for pain and associated symptoms of migraine without aura
D. Has at least two of the following:

  • Unilateral location
  • Pulsating quality
  • Moderate or severe pain intensity
  • Aggravation by or causing avoidance of routine physical activity

E. Has at least one of the following:

  • Nausea and/or vomiting
  • Photophobia and phonophobia

F. No medication overuse and not attributed to another causative disorder


Treating chronic migraines can be very difficult. In many cases, tolerance to medications develops resulting in attacks occurring more frequently. Changes in sleep patterns, especially those of shift workers, can trigger an episode, especially if they result in loss of sleep. There may also be unidentified ‘triggers’, such as food sensitivities or stress, that may be responsible for what seem (to the patient) to be causing constant migraines.

Many of the therapies prescribed for chronic migraines include both prescription and over the counter painkillers and as well as migraine-specific drugs such as triptans, known as abortive medications.
A combination of lifestyle changes and understanding the migraine triggers is critical when treating chronic migraines.

Basilar Type Migraine


A basilar migraine, also known as a basilar-type migraine (BTM), is a subtype of migraine with aura symptoms originating from the brainstem or the simultaneous involvement of both hemispheres. This type of migraine is also referred to as basilar artery migraine, Bickerstaff syndrome, vertebrobasilar migraine and brainstem migraine.


According to the American Headache Society, the symptoms experienced by BTM sufferers, in order from most to least common, are as follows:


100% of BTM patients describe having this symptom. 40% say they experience symptoms in both fields of vision while 60% only experience aura on one side or the other. Aura most commonly consists of a spinning sensation (vertigo), noise in the ears (tinnitus), double vision (diplopia), hearing problems (hypacusia), poor limb coordination (ataxia), and unpleasant sensations in the face arms or legs (ranging from prickling to stinging to burning). Temporary blindness can also occur, which is one reason BTM can be so scary.


98% of sufferers say they experience migraine-level headaches without aura, during aura, or within 60 minutes of aura symptoms occurring.


This is when the ability to speak, read or write properly is affected. 40% of basilar migraine patients report this symptom.

Each aura is different and each aphasic experience may be different from the next as well. These symptoms can be frightening, but understanding them will provide needed comfort when experiencing them.


A basilar type migraine diagnosis is made based on imaging tests, such as MRI and CT scan and possibly a lumbar puncture. It is possible that a diagnosis of basilar type migraine can be missed or delayed because it is rare and because symptoms can be similar to other migraine symptoms and conditions. A proper medical evaluation is performed to rule out other conditions and migraine types.


Basilar type migraines can be treated by numerous ways, which include:

  • Biofeedback therapy to teach the patient how to monitor and respond to physical responses of an impending migraine attack
  • Relaxation therapy to provide pain relief during a basilar migraine
  • Cognitive behavioral therapy to help patients cope with stress and change the way their body reacts to anticipated migraine pain
  • Anti-seizure drugs (topiramate, divalproex or valproate)
  • Beta-blockers (propranolol, timolol or metoprolol)
  • Antidepressants (amitriptyline or venlafaxine)