Sometimes migraine can cause symptoms and complications in other parts of the body. These migraine variants are often named according to the part of the body that’s affected. Most people who experience migraine variants also experience more typical migraine episodes.
A doctor may be able to tell if your symptoms indicate that you have one of these rare or extreme types of migraine or another condition altogether.
Hemiplegic migraine affects a very small percentage of people in the United States.
People with hemiplegic migraine attacks experience paralysis or weakness on one side of the body, disturbances in speech and vision, and other symptoms that often mimic a stroke. The paralysis is usually temporary, but it can last for several days.
Two types of hemiplegic migraine exist:
- Familial hemiplegic migraine (FHM). FHM is an inherited genetic migraine disorder that causes hemiplegic migraine. Genetic testing can determine whether you have the gene mutations that are associated with this migraine variant. If your parent, sibling, or child has FHM, the chances of you having FHM are higher.
- Sporadic hemiplegic migraine (SHM). SHM is associated with hemiplegic migraine that occurs in people without the genetic disorder and without a family history of hemiplegic migraine. If you don’t have a relative with diagnosed hemiplegic migraine, doctors may indicate you have SHM.
Both FHM and SHM are diagnosed after you have symptoms of hemiplegic migraine on several occasions. Both present the same way — the only difference is the presence of the known genetic risk.
Typically, a hemiplegic migraine episode will be evaluated as a medical emergency in order to rule out a stroke, even for those with a family history.
If you’re diagnosed with hemiplegic migraine your neurologist should instruct you as to what to do if another episode occurs so you don’t have to go through a full evaluation each time an attack happens.
Children are typically most affected by abdominal migraine. Symptoms generally last 1 to 72 hours and include:
For children who have been living with this migraine variant for a longer period of time, symptoms may also include:
- attention deficit problems
- delayed development
This variant is more common in children who have a family history of migraine attacks.
Children who have abdominal migraine may be given a prescription by their pediatrician to help address episodes when they occur.
While abdominal migraine is usually not accompanied by a headache, children who have these migraine episodes are likely to have typical migraine symptoms when they reach adulthood.
People who have repeated and ongoing migraine attacks may have a variant called chronic migraine. It’s also sometimes called transformed migraine.
If you have this variant, you typically experience attacks on at least half of the days in a month. You might have migraine symptoms daily or almost daily. You may go through periods of chronic migraine followed by your typical migraine frequency.
This type of migraine typically begins in someone’s late teens or early 20s and the frequency of migraine attacks will increase over time. These migraine episodes may be triggered by something specific, such as food or a smell.
Sometimes called an intractable migraine, status migrainosus is a very serious and very rare migraine variant.
It typically causes migraine attacks so severe and long lasting — typically more than 72 hours — that you must be hospitalized.
Most complications associated with this migraine variant arise because of prolonged vomiting and nausea. Over time, you can become dehydrated and need intravenous treatment to stay hydrated.
As the name suggests, this type of migraine is related to the menstrual cycle and the changing levels of hormones that precede it.
The Massachusetts General Hospital (MGH) Center for Women’s Mental Health estimates that 7 to 14 percent of people who menstruate experience migraine symptoms during the premenstrual or menstrual phase of their cycles.
Migraine attacks caused by menstruation are typically more severe and last longer than migraine attacks at other times of the month.
Retinal migraine is a rare migraine variant characterized by repeated instances of visual disturbances, such as blind spots or blindness on one side of the field of vision.
These disturbances may last between a minute and an hour and usually occur before head pain begins.
Basilar migraine (migraine with brainstem aura)
Basilar migraine, also known as Bickerstaff syndrome or migraine with brainstem aura, typically causes dizziness and vertigo prior to head pain.
But this migraine variant may also cause the following symptoms prior to pain:
- ringing in the ears
- slurred speech
- loss of balance
- syncope (fainting)
- loss of consciousness
This type of migraine attack is most common in adolescent girls and young women, so researchers believe it’s likely related to the hormonal changes that affect people at these ages.
What is the most severe type of migraine?
All migraine types can cause significant pain and may interfere with daily life. Some types, including status migrainosus or hemiplegic migraine, may even lead to hospitalization.
However, the severity of a migraine episode is dependent on many factors, making it difficult to definitively assess a single type as the most severe.
What can be mistaken for a migraine attack?
Some other types of headaches, including tension headaches and medication overuse headaches, may sometimes be mistaken for migraine. Other conditions that cause pain in the head — including sinus infections and the flu — may also resemble migraine pain.
More serious conditions, including hypertension and stroke, can also cause symptoms similar to migraine. For this reason, it’s important to discuss your symptoms with a medical professional so you can work together on an accurate diagnosis.
What can I do if a migraine attack won’t go away?
If a migraine episode lasts longer than a day or returns several times within a month, it’s important to speak with a doctor.
You should seek immediate medical attention if you experience:
- a sudden, severe headache
- a headache accompanied by neck stiffness
- a migraine headache that has persisted for several days
- the onset of new symptoms, such as vision loss, confusion, or fever
Migraine symptoms can vary widely and mimic other conditions. Speak with your doctor immediately if you experience symptoms not typically associated with your usual migraine symptoms.
These may include:
- slurred speech or drooping on one side of the face
- weakness in the limbs
- symptoms accompanied by double vision, fever, neck stiffness, confusion, seizure, or numbness
- symptoms much more severe than usual
- any loss of consciousness
Keeping track of your symptoms, their severity, and how often they occur can help you better understand changes.
There are many treatment options to explore with your healthcare team. Talk with them about your triggers to aid in preventing migraine attacks.