Migraines are a type of headache characterised by recurring episodes of moderate to severe head pain, often accompanied by other symptoms. There are several different types and phases of migraines.
What is an aura?
In different types of migraines, there exists a subtype known as migraines with aura. The term “aura” refers to specific neurological symptoms that precede or accompany a migraine episode.
According to Dr Nitin Menon, consultant-neurology, P.D. Hinduja Hospital and Medical Research Centre, Mumbai, aura is a disturbance in vision, speech or sensation which may occur before or during a migraine episode. Typically, they appear as flashes of light, tingling in limbs or disturbance in speech. They occur in about 25 per cent of all migraine patients.
Types of migraines
The types of migraines, according to Dr Menon are:
Migraine without aura: This is the most common type of migraine. It characterises with moderate to severe headache mostly on one side of the head and may accompany with nausea, vomiting, and sensitivity to light and sound. This type of migraine does not have an aura, which is a visual or sensory disturbance that sometimes precedes the headache.
Migraine with aura: Migraines with aura distinguish themselves by the presence of specific neurological symptoms like visual disturbances, heightened sensitivity to noise, and so on (symptoms referred to as auras) which precede or accompany the headache. Auras can include visual disturbances (such as flashing lights or blind spots), sensory changes (tingling or numbness), or even difficulty speaking.
Chronic migraine: Chronic migraine is diagnosed when a person experiences headaches for 15 days or more every month, for at least three months, and with at least eight of those headaches being migraines. These individuals have frequent and often disabling headaches.
Menstrual migraine: Some women experience migraines that are closely linked to their menstrual cycle. These migraines often occur in the days before, during, or after menstruation.
Vestibular migraine: Vestibular migraines are characterised by dizziness and problems with balance, in addition to the typical migraine symptoms. People with vestibular migraines may experience vertigo (a spinning sensation), problems with coordination, and unsteadiness.
Retinal migraine: This is a rare type of migraine which is distinguished by temporary vision loss or blindness in one eye. The vision loss usually lasts less than an hour and is often accompanied by a headache.
Hemiplegic migraine: Hemiplegic migraines are characterised by temporary paralysis or weakness on one side of the body, which can mimic the symptoms of a stroke. Other symptoms include vision changes, difficulty speaking, and confusion.
Ocular migraine: Temporary visual disturbances or vision loss in one eye cause this type. Unlike retinal migraines, ocular migraines typically do not cause headache.
Acephalgic migraine (silent migraine or visual migraine): Acephalgic migraines are unique because they occur without the typical headache pain associated with migraines. Instead, individuals experience other migraine symptoms, such as visual disturbances (aura), nausea, vomiting, and sensitivity to light and sound. These visual disturbances can be like those experienced with migraines with aura but occur without the subsequent headache phase.
Abdominal migraine: Abdominal migraines primarily affect children, although they can occur in adults as well. Recurrent episodes of severe abdominal pain, nausea, and vomiting characterise this type of migraine, with the pain centering in the abdomen rather than the head, unlike typical migraines.
Phases of migraine
Migraines typically progress through several distinct phases. However, not everyone with migraines experience all these phases. The duration and severity of each phase could vary as well from person to person.
According to Dr Ria Emmanuel, ENT consultant specialised in allergy and immunotherapy, Narayana Multispeciality Hospital, Bengaluru, the phases of migraine are:
Prodrome phase (preheadache phase): This phase can occur hours or even days before the onset of the headache itself. Common prodromal symptoms include fatigue, mood swings, food cravings and so on. Some people may also experience early warning signs such as muscle stiffness or yawning.
Aura phase (if present): Not everyone with migraines experiences an aura, but for those who do, it occurs before the headache phase. Auras are usually visual disturbances but can also involve sensory symptoms or motor symptoms. Visual auras often include flashing lights, zigzag lines, blind spots, or other visual disturbances. Sensory auras may involve tingling or numbness in the face or extremities, and motor auras can lead to muscle weakness or difficulty with coordination. Aura lasts for less than an hour and is reversible.
Headache phase: This is the most well-known phase of a migraine. It involves moderate to severe headache that is often throbbing or pulsating in nature. The pain is usually on one side of the head but can occur on both sides. Other symptoms that can accompany the headache phase include nausea, vomiting, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). This phase can last for hours to days.
Postdrome phase: After the headache phase subsides, individuals often enter the postdrome phase. This phase can last for hours to days. During the postdrome phase, people may feel drained and fatigued. They may also experience mood changes, such as feeling irritable or euphoric. Some people report a sense of relief during this phase, while others may still experience residual symptoms.
People who experience migraine may or may not go through all the phases and specific symptoms. Understanding these phases can be helpful for tracking and managing migraines, and for differentiating them from other types of headaches. If you experience headaches frequently make sure to consult an expert at the earliest.