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Complex or Complicated Migraine - What Are They?


There are always a lot of questions about different types of Migraines. Frequently, I'm asked about "complex Migraines" or "complicated" Migraines. That's a difficult question to answer because it varies depending on who's using those terms.

In most areas of medicine, terminology and diagnostic classifications are standardized so that diagnoses are uniform and when one is mentioned, logical discussion or search for information can follow. That applies in the field of what's generally called "headache medicine," the diagnosis and treatment of Migraine and other headache disorders, as well. The International Headache Society's International Classification of Headache Disorders, 2nd Edition, (ICHD-II) is the gold standard for diagnosing and classifying headache disorders.

Under ICHD-II, there is no classification of "complex" on "complicated" Migraine. Sometimes, "complex" or "complicated" are used as descriptive terms, as opposed to diagnoses, to describe a Migraine attack that is more complex or complicated than they consider to be "normal" or "average." If you hear or see someone using those terms meaning them to be diagnoses of a particular form of Migraine, it's quite difficult to know what they really mean. Since there's no defined criteria or reference for either of them as forms of Migraine, what one person means may be very different from what another person means.

It's helpful to know the types of Migraine that are recognized in the ICHD-II. They are:

1.1 Migraine without aura

1.2 Migraine with aura

1.2.1 Typical aura with migraine headache
1.2.2 Typical aura with non-migraine headache
1.2.3 Typical aura without headache
1.2.4 Familial hemiplegic migraine (FHM)
1.2.5 Sporadic hemiplegic migraine
1.2.6 Basilar-type migraine       

1.3 Childhood periodic syndromes that are commonly precursors of migraine

1.3.1 Cyclical vomiting
1.3.2 Abdominal migraine
1.3.3 Benign paroxysmal vertigo of childhood

1.4 Retinal migraine

1.5 Complications of migraine

1.5.1 Chronic migraine
1.5.2 Status migrainosus
1.5.3 Persistent aura without infarction
1.5.4 Migrainous infarction
1.5.5 Migraine-triggered seizures

1.6 Probable migraine

1.6.1 Probable migraine without aura
1.6.2 Probable migraine with aura
1.6.5 Probable chronic migraine

If you've been diagnosed with "complex Migraine, "complicated Migraine," or any form of Migraine not listed above, please ask your doctor for an accurate and full diagnosis. It may not seem that it should matter, but it does. Here's just one reason why: Triptans (Imitrex, Maxalt, Zomig, and the others) and ergotamines (D.H.E. 45, Cafergot, and Migranal Nasal Spray) are usually not prescribed for people with basilar-type or hemiplegic Migraines because there's concern about their vasoconstrictive (constricting blood vessels) properties.

If your doctor can't or won't give you an accurate and full diagnosis or give you a good reason why not, you need to find a new doctor. Knowledge is power, and we need all the power we can get to live with Migraine disease, work with our doctors as treatment partners, and take good care of ourselves.


The International Headache Society. "The International Classification of Headache Disorders, 2nd edition." Cephalalgia 2004; 24 suppl 1:1-160.


Medical review by John Claude Krusz, PhD, MD


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Teri Robert, 2011. Last updated February 20, 2011.

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