Complex migraine can refer to migraine that causes atypical, stroke-like symptoms, such as aura. Doctors typically use more specific terms to refer to these types of migraine.

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Migraine and complex migraine can both be debilitating.

Doctors don’t typically use the term “complex” migraine but rather, they use the terms:

  • migraine with aura
  • atypical migraine
  • hemiplegic migraine

Keep reading to find out more about this migraine type. However, if at any time you think you could be having a stroke, seek immediate emergency attention.

Complex migraine causes an “aura” before migraine that includes stroke-like symptoms.

An aura is a symptom that migraine is coming. When a person has complex migraine, this aura often lasts longer than it does for people who have other types of migraine.

The term “complex migraine” isn’t one that doctors use as frequently as they may have a decade ago.

“Complex migraine” is no longer a frequent term because the term is often a catch-all term that describes migraine symptoms that cause:

  • stroke-like symptoms
  • symptoms with severe auras
  • migraine with auras that lasted longer than typically expected

This article explores all three of these complex migraine symptoms.

A lack of a clear complex migraine definition led doctors to start using more specific clinical terms to describe them.

An example of a clinical term is a rare migraine type called hemiplegic migraine. It causes weakness or paralysis on one side of your body due to an aura.

Ophthalmoplegic migraine causes pain around your eye and visual changes that may last several weeks due to migraine. These descriptions allow doctors to more specifically define complex migraine.

Some people experience complex migraine on a weekly basis while others may only experience this once or twice in their lifetimes. As a general rule, a person has fewer migraine episodes as they get older.

Some people may be able to link their complex migraine to certain triggers. Examples of common migraine triggers include:

  • eating certain foods
  • exercise or physical exertion
  • excessive sleep
  • exposure to extremely bright lights
  • lack of sleep
  • smelling strong smells
  • stress

However, there are also times when a person can’t link their migraine back to any one cause. This can make migraine more challenging to prevent.

Complex migraine symptoms can vary from person to person. However, this migraine type usually has two phases.

The first phase is an aura episode. The aura is like a precursor to migraine, but it doesn’t mean its symptoms are any less severe.

The aura phase typically begins shortly before migraine occurs. Symptoms of complex migraine aura might include the following:

  • vision changes, including blind spots, bright flashes of light, or double vision
  • changes in your ability to think clearly
  • difficulty speaking or difficulty speaking clearly
  • weakness on one side of your body that ranges from mild to severe

The most significant aura symptoms usually last about an hour but may have lingering effects for up to a week, according to the National Organization for Rare Disorders (NORD).

Following an aura comes migraine. Migraine causes symptoms such as:

  • nausea
  • sensitivity to light and sound
  • throbbing, intense headache pain
  • vomiting

NORD also emphasizes that migraine can last for several days in some people. But what’s important to know about complex migraine symptoms is that they are reversible.

A person who has complex migraine will ultimately have symptoms that go away. It may take a little longer due to the nature of complex migraine.

But it’s important to know that the experience of complex migraine is different from a person who experiences a stroke, which may have lasting effects.

If you can link your migraine to environmental triggers — like the smell of cigarette smoke or drinking red wine — you can usually avoid these to prevent complex migraine. Stress may be more difficult to avoid, but not impossible.

To treat complex migraine, doctors may also prescribe medications that may help brain chemistry. You may need to try different treatments or combinations of treatments before you find one that may help reduce migraine days.

Examples of preventive treatments may include:

  • antiseizure medications
  • beta-blockers
  • calcium channel blockers

If you rarely have migraine, doctors don’t usually recommend the above treatments. Preventive medications are usually reserved for people who have migraine days frequently, which interfere with their daily activities.

Researchers have detected changes in three genes that may cause hemiplegic migraine or those that lead to weakness on one side if your body. Specifically, these genes are:

  • ATP1A2
  • SCN1A

These genes help with nerve cell function in your brain. However, doctors haven’t defined how changes in these genes lead to migraine.

If you have a family history of complex migraine, you’re more at risk of developing this type.

NORD defines the inheritance pattern as a 50 percent risk that a parent will pass the gene on to a child with each pregnancy.

However, many people with complex migraine don’t have a family member with this migraine type.

Females seem to experience hemiplegic migraine at higher rates than males do, according to NORD.

When to seek medical care for migraine

Because complex migraine mimics stroke symptoms, it can be difficult to know if you should seek emergency care related to your symptoms.

Since time is of the essence when it comes to treating stroke, it’s best to seek emergency treatment for symptoms like:

  • weakness on one side
  • facial drooping
  • sudden changes in consciousness level

If your symptoms progress to migraine usually within 5 minutes to an hour, talk with your doctor about potential migraine treatments.

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Migraine treatment often depends upon the specific symptoms a person has.

To treat the immediate symptoms, you may take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen. Doctors may also prescribe anti-nausea medications or pain relief medications.

According to the American Migraine Foundation, if a person has hemiplegic migraine, a doctor doesn’t usually prescribe treatments such as triptans and ergotamines. These medications can cause blood vessel constriction and don’t usually address the symptoms.

Engaging in preventive strategies (like avoiding migraine triggers) may also help reduce migraine days.

Doctors diagnose an estimated 2 percent of all patients with stroke-like symptoms with migraine, according to a 2019 research review.

When it comes to complex migraine, it can be difficult to differentiate between the two. However, if you have a history of complex migraine, you may recognize the aura symptoms more easily.

Your doctor may recommend seeing a specialist called a neurologist to treat complex migraine as their treatment is more complex.

A neurologist can conduct examinations and prescribe treatments when indicated to address complex migraine symptoms.

Although doctors don’t use the term “complex migraine” as often, the symptoms this migraine type can cause are alarming. They include:

  • weakness on one side
  • difficulty speaking
  • vision changes

If you have these symptoms and aren’t sure what they may be related to, seek immediate medical attention.