Migraine is a genetic neurological disease. Because there are several different types of Migraine, and some forms involve different genetic markers, some researchers theorize that it may actually be more than one disease. For now, however, Migraine is divided into two major subtypes, Migraine without aura (MWOA) and Migraine with aura (MWA). There is a single classification under Migraine without aura. MWOA is the most common form of Migraine. MWA is the second most common, occurring in 25-30% of Migraineurs. Few people have the aura phase with every Migraine attack. Thus, it’s quite common to be diagnosed with both MWA and MWOA.

Migraine is a common disabling primary headache disorder. Epidemiological studies have documented its high prevalence and high socio-economic and personal impacts. It is now ranked by the World Health Organization as number 19 among all diseases world-wide causing disability.

For consistency in diagnosing and classifying head pain disorders, the International Headache Society’s International Classification of Headache Disorders, Second Edition (ICHD-II), is generally accepted as the “gold standard.” Hemiplegic and basilar-type Migraine are subtypes of Migraine with aura. For the purposes of this article, we’ll be discussing 1.2.1, “typical aura with migraine headache.” The ICHD-II classification criteria:

1.2 Migraine with aura
Previously used terms:
Classic or classical migraine, ophthalmic, hemiparaesthetic, hemiplegic or aphasic migraine, migraine accompagnée, complicated migraine

1.2.1 Typical aura with migraine headache

Description:
Typical aura consisting of visual and/or sensory and/or speech symptoms. Gradual development, duration no longer than one hour, a mix of positive and negative features and complete reversibility characterise the aura which is associated with a headache fulfilling criteria for 1.1 Migraine without aura.

Diagnostic criteria:

1. At least 2 attacks fulfilling criteria B–D
    
2. Aura consisting of at least one of the following, but no motor weakness*:
   1. fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision)
   2. fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)
   3. fully reversible dysphasic speech disturbance
3. At least two of the following:
   1. homonymous visual symptoms1 and/or unilateral sensory symptoms
   2. at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
   3. each symptom lasts ≥5 and <60 minutes
4. Headache fulfilling criteria B–D for 1.1 Migraine without aura begins during the aura or follows aura within 60 minutes
5. Not attributed to another disorder

* If the aura includes motor weakness, code as 1.2.4 Familial hemiplegic migraine or 1.2.5 Sporadic hemiplegic migraine. (See What Is Hemiplegic Migraine?)

For more detailed information about aura symptoms, please see Anatomy of a Migraine.

Some differences in children:

1. In children, attacks may last 1–72 hours.
2. The headache of a Migraine attack is commonly bilateral (on both sides) in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adulthood.
3. In young children, photophobia and phonophobia may be inferred from observing their behavior.
4. The headache of a Migraine attack is usually frontotemporal (front and sides, toward the front, of head). Occipital (lower back of the head) headache in children, whether unilateral or bilateral, is rare and calls for caution in diagnosing as many cases are attributable to structural lesions.

In MWA, a Migraine attack can consist of up to three phases:

1. Prodrome
2. Aura
3. Headache Phase
4. Postdrome

See Anatomy of a Migraine for a complete description of these phases and their symptoms.

It’s important to note that you can have more than one type of Migraine. It’s also not unusual to experience both headaches and Migraines. In fact, tension-type headaches can be a Migraine trigger.

If your doctor has diagnosed you with “Migraines,” ask for a more definitive diagnosis. That will make it easier for you to find information and learn about Migraine disease as it applies to you.

____________
Resources:

¹ The International Classification of Headache Disorders, Second Edition. The International Headache Society. 2004.
  

Medical review by John Claude Krusz, PhD, MD

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© Teri Robert, 2004 - Present. Last updated June 14, 2010.

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