The most common migraine classifications are migraine without aura and migraine with aura. However, several rare subtypes have certain patterns that help in directing treatment.

If you experience migraine, you may be more interested in how to stop the intense pain of migraine headaches than in identifying which type of migraine you may have. However, being aware of the various types of migraine can help you be better prepared to seek the proper treatment.

Keep reading to learn more about how doctors classify migraine according to your symptoms and how your specific type may influence your treatment plan.

You may think of “aura” as a new-age term, but when it comes to migraine, there’s nothing ethereal about it. Aura is a neurological symptom affecting your vision or other senses, and it can occur before, during, or instead of migraine pain.

About one-quarter of people with migraine experience aura, previously called “classical migraine.”

About 90% of migraine auras involve visual disturbances, such as:

  • zig-zagging lines
  • lights that look like stars or dots
  • blind spots
  • distorted vision
  • temporary vision loss

Aura can also affect other senses, speech, and movement. Examples of other symptoms include:

  • tinnitus (ringing in your ear)
  • noticing strange odors
  • tingling in a limb or one side of your face
  • allodynia (pain from things that don’t usually cause pain)
  • dysphasia (affected speech and understanding), rarely

Aura symptoms typically last 60 minutes or less and usually stop when headache pain begins. However, some people continue to experience aura during the headache phase.

An aura can also begin during the painful phase. And rarely, people with migraine can experience an aura without having a headache phase during the event.

Treatment

People often find some relief from migraine with aura by finding a dark, quiet environment. Several migraine medications can help you manage symptoms, especially if taken within 15 minutes of their onset. These include:

Migraine phases

People who experience migraine with aura often go through four phases:

  1. Prodrome: subtle warning signs up to several days before migraine episode
  2. Aura: sensory symptoms up to 60 minutes before headache pain or during the pain phase
  3. Headache: pain phase that can last up to 3 days
  4. Postdrome: “hangover” phase that can last up 2 days

More commonly, migraine occurs without aura. People with this type of migraine typically go through all the other features of a migraine attack, including:

  • pulsing or throbbing headache pain (often on one side for adults but both sides for children)
  • nausea
  • vomiting
  • sensitivity light or sound

Common migraine warning signs include craving sweets or feeling thirsty or sleepy.

In some cases, migraine without aura can be accompanied by anxiety, depression, or fatigue that generally sets in several hours prior to the headache pain.

Migraine without aura is common during the premenstrual stage of the menstrual cycle, a few days before a period begins.

Treatment

Migraine treatment is similar for people with or without aura. However, experts note that people who experience migraine without aura are most likely to develop worsening symptoms with frequent use of medications.

Previously called “basilar migraine,” migraine with brainstem aura is a rare subtype of migraine with aura in which symptoms begin in the brainstem. However, motor weakness is not present.

People who experience migraine with brainstem aura experience typical aura symptoms but may also experience:

  • slurred speech
  • vertigo
  • tinnitus
  • hearing loss
  • double vision
  • diminished coordination
  • lethargy

Treatment

Doctors generally treat migraine with brainstem aura like other types of migraine. However, because the condition is rare, there’s not as much research into the safety and efficacy of certain medications. Doctors may avoid prescribing triptans and ergotamines because of an increased risk of ischemic stroke.

Hemiplegic migraine is another subtype of migraine with aura. But unlike basilar migraine, it includes motor weakness as a symptom.

Motor auras are rare, but people with hemiplegic migraine often experience weakness (usually on one side of their body) in addition to other typical aura symptoms. Motor symptoms often start in the hands before moving to the arms and face.

Unlike typical aura symptoms, motor weakness in hemiplegic migraine episodes can last for weeks.

Symptoms of severe episodes may include:

  • delusions
  • drowsiness
  • seizures
  • confusion
  • agitation

Some people have a genetic mutation that increases their risk of hemiplegic migraine. This is called familial hemiplegic migraine (FHM). Doctors call cases not linked to a family history “sporadic hemiplegic migraine.”

Treatment

Treatment for hemiplegic migraine is similar to other types of migraine. Like with basilar migraine, doctors typically don’t prescribe triptans or ergotamines as they can increase the risk of ischemic stroke. Some doctors may also recommend avoiding beta-blockers as a preventive medication.

Acetazolamide, a diuretic, may be an effective preventive medication in people with a specific subtype of FHM, though researchers are unsure why.

In retinal migraine, the visual aura symptoms only affect one eye. In that eye, you may experience:

  • temporary partial or full vision loss
  • flashing lights
  • black, shaded, or white areas in your field of vision
  • scintillating scotomas

Treatment

Doctors don’t usually prescribe treatments for during retinal migraine episodes as the symptoms don’t last as long as it would take for the medications to work. However, calcium channel blockers (CCBs) like nifedipine (Procardia) and verapamil (Verelan) may help prevent episodes.

People with retinal migraine should avoid triptans, ergotamines, and beta-blockers as they increase the risk of permanent vision loss.

It’s possible to experience migraine aura without subsequent headache pain. The official term for this is typical aura without headache, but some people refer to it as silent or acephalgic migraine. The lack of headache pain can sometimes make diagnosing this condition challenging.

With silent migraine, aura symptoms typically last no longer than an hour. The prevalence of silent migraine may increase with age, according to the American Migraine Foundation.

Treatment

Treatment options for silent migraine include low dose aspirin, CCBs, and other preventive medications.

If you experience headaches 15 or more days in a month for 3 consecutive months, with at least 8 of those days featuring migraine symptoms, a doctor may diagnose you with chronic migraine. Doctors classify less frequent headaches as episodic migraine.

Chronic migraine is much rarer, affecting only about 8% of people with migraine.

Treatment

People with chronic migraine may not respond as well to primary treatments as people with episodic migraine, especially treatments to stop an ongoing episode, like triptans and NSAIDs. However, preventive treatments may reduce headache frequency.

Other key preventive strategies include:

According to the American Migraine Foundation, less than half of people with migraine seek medical help. As migraine symptoms can vary considerably, it can be challenging to know whether you may be experiencing migraine or not without a doctor’s help.

Contact a doctor if you:

  • experience headaches or aura symptoms more than once a week
  • if your symptoms are getting worse or lasting longer than usual
  • symptoms are affecting your daily activities

Regardless of type, migraine can be a debilitating condition. Preventive measures may help reduce the frequency and severity of migraine episodes.

Reducing stress through relaxation, exercising, ensuring proper sleep, and avoiding personal food triggers may help you limit or even prevent migraine attacks.