Types of Migraine headache symptoms

1. Migraine without aura, according to the International Classification of Headache is diagnosed by a headache pattern fulfilling the following criteria:

  • A. At least five attacks fulfilling B-D.

  • B. Attacks lasting 4-72 hours (untreated or unsuccessfully treated).

  • C. At least two of the following characteristics:    

  1. Unilateral (one sided) location.    
  2. Pulsating (throbbing) quality.    
  3. Moderate or severe intensity (inhibits or prohibits daily activities).    
  4. Aggravation by walking stairs or similar routine activity.  
  • D. At least one of the following:      

  1. Nausea and/or vomiting.      

  2. Photophobia (sensitivity to light) and phonophobia (sensitivity to sound).  

Migraine without aura used to be called “common” migraine because it is the most prevalent type of migraine, consisting of about 70% of all attacks.  Typically, the patient has one-sided headache (migraine comes from a French word that means half of head or hemicrania), nausea, vomiting, photophobia (fear of light), sonophobia (fear of sounds), and goes to sleep in a quiet, dark room.  This is often called wake up headache, sick headache, sinus headache, heat or sun headache, menstrual headache, letdown headache (a headache that comes during a weekend, vacation, or holiday), cold front or weather change headache (from a drop in the barometric pressure), or nocturnal headache (middle of the night, end of a dream headache.)  The patient may not know she has migraine but comes for treatment and diagnosis of headache.

2. Migraine with aura.  This used to be called “classical” migraine and consists of an aura, usually followed by headache.  30% of migraine attacks are like this.  The aura may be visual, such as seeing wavy lines, spots, or holes, or half of things.  The aura may also consist of slowly spreading numbness in one hand or the face on the same side, or a temporary disturbance of language (aphasia.)  The aura symptoms may be frightening and much more concerning than the headache.  Visual aura symptoms may occur without headache.

These criteria for migraine diagnosis are used in headache clinics all over the world.