Migraine syndromes

Generally, there are several different migraine syndromes that may occur:

• migraine without aura (common migraine)
• migraine with aura (classical migraine)
• basilar artery migraine
• hemiplegic migraine
• ophthalmoplegic
• cluster headache - migrainous neuralgia

The most common are common migraines (without aura) and classic migraines ( with aura) (1)

• Migraine without aura (common migraine)
  • diagnosis requires at least five attacks, all fulfilling the following criteria:
    • headache lasts 4-72 hours (untreated or unsuccessfully treated)
    • headache has at least two of the following characteristics
      • unilateral location
      • pulsating quality
      • moderate or severe pain intensity
      • aggravation by, or causing avoidance of, routine physical activity
    • during the headache at least one of the following is present
      • nausea and/or vomiting
      • photophobia and phonophobia
      • the attack is not attributable to another disorder
    • headache is usually frontotemporal. It is usually unilateral, but may be bilateral at the onset, or may start unilaterally and become generalized
    • onset of the headache is usually gradual, peaking after 2-12 hours, then gradually subsiding
    • attacks often begin in the morning, possibly waking the person from sleep, but may begin at any time of day or night
    • frequency of attacks is extremely variable:
      • some people may have several attacks a week
      • others may go for years between attacks
      • other features that may occur during an attack include anorexia, blurred vision, impaired concentration, nasal stuffiness, hunger, tenesmus, diarrhoea, abdominal pain, polyuria, pallor, sweating, and sensations of heat or cold
      • examination during an attack may reveal localized oedema of the scalp, face, or under the eyes; scalp tenderness; prominence of temporal blood vessels; or neck stiffness and tenderness
• Migraine with aura (classical migraine)
  • diagnosis requires at least two attacks, both fulfilling the following criteria:
    • aura has at least one of the following characteristics (but no motor weakness)
      • fully reversible visual symptoms (e.g. flickering lights, spots or lines; or loss of vision)
      • fully reversible sensory symptoms (e.g. paraesthesiae, numbness)
    • the aura, in addition, has at least two of the following features
      • visual symptoms are homonymous (affect both visual fields on the same side), or the sensory symptoms are unilateral
      • at least one symptom develops gradually over more than 5 minutes, or different symptoms occur in succession over more than 5 minutes
      • each symptom lasts 5-60 minutes
    • the headache begins during the aura, or follows the aura within 60 minutes
    • the attack is not attributable to another disorder
  • visual aura is the most common type of aura. They may move across the visual field, and may cross the midline. Examples of visual aura are:
    • fortification spectra, which are often 'C'-shaped
    • scotoma
    • objects may rotate, oscillate, or 'boil'
    • simple flashes, specks, and shimmerings
    • paraesthesiae are the second most common type of aura. Numbness usually starts in the hand, migrates up the arm, then involves the face, lips, and tongue. The leg is sometimes involved. Numbness may follow the paraesthesia. Sensory auras rarely occur alone, and usually follow visual auras
    • speech disturbances are the third most common type of aura. These are usually dysphasia, but are often hard to categorise
    • most people who have migraine with aura also have episodes of migraine without aura
      
      
• Chronic migraine
  • Headaches (suggestive of migraine or tension headaches) on >= 15 days/month for >3 months that fulfill the following criteria:
    • occurring in a patient who has had at least five attacks meeting the criteria for migraine without aura or the criteria for migraine with aura or both
    • on >= 8 days/month for >3 months, features of migraine without aura or of migraine with aura or believed by the patient to be migraine at onset that is relieved by a triptan or ergot derivative
      

Reference:

1. Patient Information Collection.Migraine Headaches: How to Deal with the Pain.American Family Physician 2005; 72: 9
2. Silberstein SD, Lipton RB and Goadsby PJ (2002). Headache in clinical practice. 2nd edition.London: Martin Dunitz.
3. Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211