Migraine variants

Timothy C. Hain, MD

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About 10% of the population has Migraine. There are many variants, of which the most common are described below.

Fortification spectra, as might be seen in Migraine with aura. Scotoma with aspects of a fortification.

Classic migraine: Migraine headache with aura (loss of vision or other visual symptoms, paresthesias, motor dysfunction) precedes the throbbing headache. 15-20% of migraines are classic (Russell and Olesen, 1996). Migraine with aura may be the first sign of CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.) .

Common migraine: Migraine headache without aura. About 80% of migraines are of this type (Russell and Olesen, 1996).

Vertebrobasilar migraine : headache accompanied by dizziness or ataxia, hearing symptoms (other than phonophobia), nausea and vomiting, and sometimes loss of consciousness. This is rather common as about 1/3 of all persons with migraine experience true vertigo. See related page on "Migraine associated Vertigo".

Transient monocular blindness can occur in migraine, particularly those associated with elevated antiphospholipid antibodies or lupus anticoagulant (Donder et al, 1998; Levine et al, 1988). However recent work (Donder et al, 1998) suggests that among patients with lupus, no significant relation can be found between transient monocular blindness and the presence of APA or livedo reticularis. This observation suggests that APA may be a symptom of lupus rather than a cause of transient monocular blindness.

Acephalgic migraine: Aura without headache. This diagnosis is generally made when persons who have headache and aura, also have aura without headache. Acephalgic migraines are generally thought to occur only about 1% of the time, but this is a hard number to pin down.

Complicated migraine is accompanied by a neurological deficit. Familial hemiplegic migraine is an example of this. Complicated migraines are rare, again probably less than 1%. They tend to reoccur in the same people rather than being scattered randomly across all migraine occurences. Patients with migraine and small infarcts on their MRI are another group.

Ophthalmoplegic migraine, patients present with double vision. Third nerve palsy with headache is the most common type. Again, this is a rare variant, tending to reoccur in the same people.