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.

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.” The ICHD-II classification criteria for Migraine without aura is:

1.1 Migraine without aura

Previously used terms: Common migraine, hemicrania simplex

Description:
Recurrent headache disorder manifesting in attacks lasting 4–72 hours. Typical characteristics of the headache are unilateral (one-sided) location, pulsating quality (throbbing or varying with the heartbeat), moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia (increased sensitivity to light) and phonophobia (increased sensitivity to sound).

Diagnostic criteria:

1. At least 5 attacks fulfilling criteria B–D
2. Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated)
3. Headache has at least two of the following characteristics:
   1. unilateral location
   2. pulsating quality
   3. moderate or severe pain intensity
   4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
4. During headache at least one of the following:
   1. nausea and/or vomiting
   2. photophobia and phonophobia
   3. Not attributed to another disorder

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. (See diagram.)

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

1. Prodrome
2. Headache Phase
3. Postdrome

See Anatomy of a Migraine for a complete description of these phases and their symptoms. A MWOA attack can skip the headache phase. In that case, it’s described as “acephalgic” or “silent” Migraine without aura; the diagnosis is still Migraine without aura.

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.

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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 7, 2010.

All content on this site is physician reviewed by Dr. John Claude Krusz.

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