Subtypes of Migraine: Symptoms, Causes and Treatments

Subtypes of Migraine: Symptoms, Causes and Treatments

Migraine attacks can vary significantly from person to person.  The common denominator between everything migraine is experiencing attacks that are moderate to severe, last hours to days, and are associated with pain and non-pain symptoms including sensitivities to light, sound and nausea.  Some people experience very frequent migraine attacks, some experience some of the other associated symptoms in between attacks - and based on these symptoms you may have a subtype of migraine. 

Episodic Migraine

Migraine is most commonly a problem that occurs from time to time, or “episodically”.  It’s very important to track your headache days so you can accurately tell how many migraine attacks (and days of headache at all) you experience over the course of a month.  If you experience 14 or fewer days of headache over the course of a month you have episodic migraine.  

Chronic Migraine

Some people develop very frequent migraine attacks - if you experience more than 15 days of headache per month you have a diagnosis of chronic migraine.  This is even the case even if you didn’t experience a migraine attack on those days, just symptoms of headache pain.  Often, the majority of these days don’t feel like migraines at all, they more closely resemble Tension Type Headache.  The difference though, is when your headache is most severe those exacerbations are migraine attacks.  There are specific preventive treatments your doctor might consider if you have chronic migraine, such as Botox injections. 

Vestibular Migraine

It is possible to experience non-pain symptoms on the majority of chronic migraine days, rather than the Tension Type Headache symptoms most people experience with chronic migraine.  People with vestibular migraine typically experience some feeling of instability or “dysequilibrium” - they can feel a room-spinning sensation, a rocking sensation similar to being on a boat, or just unsteadiness when walking or turning around.  These symptoms can potentially be due to a wide variety of causes, but if you experience migraine attacks together with these symptoms, it is likely that you are experiencing vestibular migraine.  This can be a more difficult-to-treat subtype of chronic migraine, and you may be recommended a kind of physical therapy called vestibular therapy in addition to medications to help treat vestibular migraine. 

Menstrual Migraine

Hormonal fluctuations are common migraine triggers, but if you experience migraine consistently around your period, you have a subtype of migraine called menstrual migraine.  It is even possible to have migraine exclusively around your menstrual period, we call this “pure menstrual migraine”.  There may be hormonal treatments that can specifically help prevent these hormonal triggers.  

Post-Concussive Migraine

The symptoms people experience after a head trauma can vary significantly, but people who have a personal or family history of migraine often experience worsening of their migraine symptoms. This can even be an increase in migraine frequency leading to a change from episodic to chronic migraine.  Although post-concussive migraine is not a technical medical term, many people describe worsening migraine after concussion this way.  Many of the standard preventive and acute medications for migraine are used when a concussion is a trigger as well. 

Identifying the correct subtype of migraine is essential for your effective treatment. Neura treats all headache disorders and migraine subtypes. If you are looking to start treatment for your headache or migraine, join Neura Health and speak with a neurologist and headache specialist via video appointment about what might work best for you.

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Thomas Berk, MD FAHS
Thomas Berk is Medical Director at Neura Health, where he treats Neura patients via video visit. He is a former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine.
About the Author
Thomas Berk, MD FAHS is Medical Director of Neura Health and a neurologist and headache specialist based in New York City. A former Clinical Assistant Professor at the Department of Neurology at NYU Grossman School of Medicine, he has over 12 years of clinical experience. He graduated from the NYU Grossman School of Medicine and completed his neurology residency at NYU as well. He completed a headache fellowship at the Jefferson Headache Center in Philadelphia. He is a Fellow of the American Headache Society and has been on the Super Doctors list of rising stars for the past five years.

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