MIGRAINE TYPES
Migraine is not a one‑size‑fits‑all condition. While most people think of migraine as a severe headache, there are actually several different types - each with its own symptoms, patterns, and triggers.
On this page, you’ll find an overview of the major migraine types, from the more familiar (like migraine with aura or genetic migraine) to rare subtypes such as ophthalmoplegic or retinal migraine. Understanding which type you may be dealing with can make a real difference in finding the right help, whether that means talking to your doctor or simply recognising your own patterns.
If you’re not sure which type fits your experience, that’s okay - migraine can be complex, and symptoms sometimes overlap. At ALLOR our goal is to provide clear, up‑to‑date information so you feel more equipped to ask questions and seek support.
If you have frequent or severe headaches, or if your symptoms ever change suddenly, it’s important to reach out to your healthcare provider for advice or further assessment.
GENETICS AND MIGRAINE
Migraines often run in families, and recent research shows that genetics play a key role in shaping who is most at risk. While anyone can develop migraine, certain inherited gene variants make some people more susceptible - especially to rare subtypes like hemiplegic migraine. These discoveries help explain why migraines sometimes cluster in families, why attacks can differ so much from person to person, and why triggers can be so varied.
What The Research Says
- Familial hemiplegic migraine is strongly linked to mutations in the CACNA1A gene on chromosome 19, with, additional gene variants (such as on chromosome 4Q) found in people who experience migraine with aura.
- Migraine is considered a "channelopathy," meaning changes in ion channels (proteins that help nerve cells communicate) are involved.
- PET scans confirm that the brainstem is activated during migraine attacks, which lines up with clinical findings of visual, sensory, and pain symptoms.
Hormonal changes (oestrogen, progesterone), pregnancy, and even trauma can influence migraine risk, especially in those with an underlying genetic predisposition.
Environmental and dietary factors like stress, sleep changes, tyramine-containing foods (e.g., chocolate, cheese), and alcohol may trigger attacks but don't cause the underlying condition.
The Role of Neurotransmitters
Migraine involves changes in the trigeminovascular system (which helps regulate head and facial pain). Neurotransmitters like serotonin and CGRP (calcitonin gene-related peptide) play key roles. This is why many modern migraine treatments target these pathways.
The Aura Link
Some migraines come with a warning phase called an "aura", which may be due to spreading waves of brain activity (spreading cortical depression). Genes can influence whether a person gets aura or not.
References
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Goadsby PJ, Holland PR, Martins-Oliveira M, Hoffmann J, Schankin C, Akerman S. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews. 2017;97(2):553-622. Full text PDF
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International Headache Society (ICHD-3): Classification of Migraine
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Genetic and Rare Diseases Information Center (GARD), NIH. Familial Hemiplegic Migraine
Ocular Migraine (and Mimics)
Ocular migraine is a term often used to describe migraine attacks that include visual symptoms, but true migraine directly caused by eye disease is rare. Most headaches with eye symptoms turn out to be classic migraine or other primary headache disorders, rather than being caused by a problem with the eye itself.
Common eye-related causes of headache (that can be mistaken for migraine) include conjunctivitis, angle-closure glaucoma, optic neuritis, orbital tumors, and rare syndromes like Tolosa-Hunt. Other contributors can include carotid artery dissection or infections like meningitis. These conditions may also cause visual changes, photophobia, or eye pain.
Because symptoms often overlap, it’s important that new or unusual visual disturbances, especially those with severe pain or vision loss, are checked promptly by a healthcare provider. Most of the time, if no structural abnormality is found and symptoms match classic migraine, no further testing is needed. But in rare cases, referral to a neurologist or ophthalmologist is essential to rule out other conditions.
References
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Carlow TJ. "Headache and the Eye: Differential Diagnosis." Seminars in Neurology. 1997;17(4):317-322. PubMed
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Biousse V, Newman NJ. "Neuro-ophthalmology and Headache." Continuum (Minneap Minn). 2015;21(4 Headache):1109-1132. Full text
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International Headache Society (ICHD-3): Migraine with Aura
Ophthalmoplegic Migraine
(Now Called Recurrent Painful Ophthalmoplegic Neuropathy)
This rare condition was once grouped under “migraine,” but is now recognized as a nerve disorder - most often affecting children and young adults. It typically causes repeated attacks of headache, usually around one eye, followed by drooping of the eyelid, a dilated pupil, or double vision on the same side.
Migraine Triggers
Instead of being triggered by classic migraine pathways, these episodes are now believed to result from inflammation or pressure on the third cranial (oculomotor) nerve. MRI scans taken during an attack sometimes show changes in this nerve, which helps confirm the diagnosis.
Most people develop their first symptoms in childhood or early adulthood. Episodes can resolve on their own over time, but sometimes lead to lasting weakness of the eye muscles. Because these symptoms can mimic much more serious conditions like aneurysms, tumors, or other nerve disorders it’s important that anyone with sudden eye muscle weakness and headache has a full neurological evaluation.
Treatments
Treatments may include corticosteroids or, occasionally, other medications, but results are variable. The term “ophthalmoplegic migraine” is now discouraged by neurology experts, who instead use “recurrent painful ophthalmoplegic neuropathy” to reflect our modern understanding of the disorder.
References
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International Headache Society (ICHD-3): Recurrent painful ophthalmoplegic neuropathy
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Goadsby PJ, Holland PR, et al. Pathophysiology of Migraine. Physiological Reviews. 2017;97(2):553-622.
Retinal Migraine
What Is Retinal Migraine?
Retinal migraine is a rare form of migraine that causes short episodes of temporary vision loss or visual disturbances in one eye only. Unlike typical migraine aura, which affects both eyes - retinal migraine is strictly one-sided. It most often affects women under 40, but anyone can experience it. Episodes usually resolve within an hour.
During an attack, vision in one eye may fade, blur, or disappear completely. Most people recover fully, but the experience can be frightening. Often, a migraine headache follows, usually on the same side as the vision loss.
Causes, Triggers, and Risks
Retinal migraine is believed to result from brief spasms or narrowing of the blood vessels supplying the retina. Genetics, hormonal changes, and vascular sensitivity all play a role. Common triggers include stress, dehydration, skipped meals, lack of sleep, bright lights, or certain foods (like chocolate or cheese).
While permanent damage is very rare, repeated or long-lasting episodes should be checked to rule out other eye or vascular issues.
Diagnosis and When to Seek Help
It’s essential to distinguish retinal migraine from other serious causes of vision loss (such as retinal detachment or vascular blockages). Always seek urgent medical review if you have sudden, one-sided vision loss, even if it quickly resolves. Diagnosis is made by ruling out other causes and may require urgent imaging with CT and/or MRI scans.
Treatment and Outlook
Most people don’t need daily medication, but avoiding triggers can help. In those with frequent or severe episodes, standard migraine preventives may be recommended. Vision almost always returns to normal within an hour, and lasting vision loss is very rare. Still, regular follow-up is important, especially if you have cardiovascular risk factors.
References
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International Headache Society. ICHD-3 Classification: Retinal Migraine (1.2.4).
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Chong YJ et al. Current Perspective on Retinal Migraine. J Clin Neurol. 2021.
Migraine With Aura
Migraine with aura is a common migraine subtype that includes a warning phase called an “aura” before the headache starts. The aura usually lasts 10 – 60 minutes and can include visual symptoms (like flashing lights, zigzags, or blind spots), as well as changes in sensation, speech, or even movement.
What Does Aura Feel Like?
Most people with aura experience changes in their vision, such as shimmering spots, zigzag lines, or patches of missing vision in one or both eyes. Sometimes, aura can cause numbness, tingling in the face or hands, trouble speaking, or rarely, weakness in one side of the body. These symptoms are usually reversible and fade completely within an hour.
Why Does Aura Happen?
Aura is thought to be caused by a wave of electrical activity (called “spreading cortical depression”) moving across the brain. This wave temporarily changes how the brain processes visual or sensory information, leading to the classic aura symptoms.
Is Migraine With Aura Dangerous?
For most people, aura is harmless but because some symptoms can mimic stroke or other serious conditions, any sudden or new symptoms (especially weakness, confusion, or vision loss) should be checked urgently by a doctor. Migraine with aura may be linked to a slightly increased risk of stroke, especially in people who smoke or use estrogen-containing birth control.
Managing Migraine With Aura
Aura symptoms can be scary, especially the first time. Learning your own patterns, avoiding known triggers (like flashing lights or lack of sleep), and talking with your family doctor (GP) about treatment options can help you manage attacks and reduce anxiety around aura episodes.
References
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International Headache Society. ICHD-3 Classification: Migraine With Aura (1.2).
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Goadsby PJ, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiological Reviews. 2017;97(2):553-622.
Other Variants
Not all migraines fit the typical pattern of pounding head pain. Some appear in childhood, others have unusual symptoms, and a few can be mistaken for serious neurological disorders. In this section, you’ll find an overview of the best-recognised rare and variant migraine types with guidance on what to look for, when to seek help, and how these conditions are usually diagnosed.
Prolonged Aura & Migraine-Related Stroke
Prolonged aura refers to aura symptoms lasting longer than the typical 60 minutes (sometimes several hours, rarely days). While most prolonged aura resolves on its own, persistent symptoms always need urgent medical attention, as they can mimic stroke.
In rare cases, a migraine attack can lead to a small stroke (migrainous infarction), where aura symptoms are prolonged and imaging shows tissue damage. This is most often seen in women under 45 with migraine with aura and additional risk factors such as smoking and/or use of estrogen-containing birth control.
Abdominal Migraine
Abdominal migraine is a rare migraine variant seen mainly in children (occasionally adults). Instead of head pain, it causes recurrent episodes of moderate / severe, midline or periumbilical abdominal pain lasting 2–72 hours, with complete wellness between attacks.
Episodes are commonly accompanied by at least two of: anorexia, nausea, vomiting, or pallor.
Headache does not occur during these abdominal episodes. Because symptoms overlap with other conditions, clinicians first must exclude gastrointestinal or renal causes.
Abdominal migraine is often seen in children with a personal or family history of migraine and many will develop typical migraine later in life.
Basilar-Type (Brainstem Aura) Migraine
This rare form officially called migraine with brainstem aura (previously known as basilar‑type migraine) presents with aura symptoms such as vertigo, double vision, slurred speech, tinnitus, or balance issues, without any motor weakness. It's most often diagnosed in teens and young adults, with many experiencing their first attack in their late teens or early 20s.
Idiopathic Stabbing Headache (Ice Pick Headache)
Idiopathic stabbing headache is often called “ice pick headache” which is characterized by sudden, sharp, stabbing pains that last just a few seconds. These pains usually occur in the front or side of the head and may strike once or many times a day, often without warning.
Although the attacks can be intense and alarming, they are generally harmless. Some people with migraine also experience ice pick headaches between their usual attacks, so the two conditions can overlap. Because the pain is so brief and unpredictable, treatment is rarely needed unless attacks are frequent.
Migraine in Childhood & Alice in Wonderland Syndrome
Some of the rarest forms of migraine begin in early childhood even as young as preschool age.
These include:
- Alice in Wonderland Syndrome (AIWS): A condition where children experience temporary distortions in body image, time, or spatial perception, feeling like they’ve shrunk, objects are stretched, or time is warped. It's strongly linked to migraine and appears most commonly in children and adolescents.
- Abdominal Migraine: Episodes of moderate to severe belly pain, often accompanied by nausea or vomiting, typically affecting school-aged children. Because headaches may be absent, it's often mistaken for stomach-related illness.
- Cyclic Vomiting Syndrome: Recurrent, intense bouts of nausea and vomiting without clear cause, frequently seen in children and often considered a precursor to or variant of migraine.
These rare presentations usually emerge only after common causes are ruled out. Many children outgrow these symptoms or develop classic migraine in later years.
Coital (Orgasmic) Headache
Coital headache is a rare type of headache brought on by sexual activity, most often around the time of orgasm.
It can present in two main ways:
- A gradual dull ache that builds with arousal.
- A sudden, explosive “thunderclap” headache at orgasm.
Most cases are benign, but because these headaches can mimic more serious conditions such as aneurysm or subarachnoid haemorrhage, a first episode should always be urgently evaluated by a doctor.
Hemiplegic Migraine
Hemiplegic migraine is a rare type of migraine that can cause temporary weakness, numbness, or even paralysis on one side of the body. Because the symptoms resemble a stroke, it can be frightening when they first occur.
Attacks often begin with visual changes or tingling, followed by weakness affecting one side of the face, arm, or leg. These symptoms usually resolve completely, but the episodes can be disabling while they last.
There are two forms:
- Familial hemiplegic migraine (FHM): runs in families.
- Sporadic hemiplegic migraine (SHM): occurs in people without a family history, but with the same features.
Because hemiplegic migraine can look so similar to a stroke, urgent medical assessment is always recommended the first time symptoms appear.
Confusional/Acute Confusional Migraine
Confusional migraine is a rare form of migraine, most often seen in children and teenagers. During an attack, the person may suddenly become confused, disoriented, or struggle to speak.
Episodes usually last from 30 minutes to a few hours, and can sometimes include headache, nausea, or visual symptoms. Afterwards, it’s common for the person to have little or no memory of what happened.
Although the symptoms can be alarming, confusional migraine generally resolves on its own and does not cause long-term problems. Because sudden confusion can also be caused by more serious conditions, urgent medical evaluation is imperative.
Vestibular Migraine
Vestibular migraine is a subtype of migraine where dizziness, vertigo, or balance problems are the main symptoms, sometimes even without a headache. People may feel as if the room is spinning, struggle with walking in a straight line, or become sensitive to visual motion. Attacks can last from minutes to several hours and often share the same triggers as other migraine types, such as stress, sleep disruption, or certain foods.
Diagnosis is usually based on a person’s symptom history and by ruling out inner ear conditions. Vestibular migraine is now recognised as one of the most common causes of recurrent dizziness.
References
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International Headache Society (ICHD-3): Classification Of Migraine
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Viana et al., The Journal of Headache and Pain volume 19, Article number: 77 (2018)
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Ying G, et al., Clinical Characteristics of Basilar‑Type Migraine, Pain Medicine (2014)
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Farooqi AM, Padilla JM, Monteith TS. Acute Confusional Migraine: Distinct Clinical Entity or Spectrum of Migraine Biology? Brain Sciences (2018)
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Raucci U, et al. Management of Childhood Headache in the Emergency Setting (2019)
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Hamed SA, et al. A migraine variant with abdominal colic and Alice in wonderland syndrome: a case report and review (2010)
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Goadsby PJ, et al. Pathophysiology of Migraine: A Disorder of Sensory Processing. Physiol Rev. (2017);97(2):553-622.
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Genetic and Rare Diseases Information Center (GARD) – Familial Hemiplegic Migraine
At ALLOR, we use Botulinum toxin (Botox®) to help manage chronic migraine, as recognised in current treatment guidelines. This is generally for people who experience headaches on 15 or more days each month, with at least 8 of those having migraine features.
We do not treat the following migraine subtypes with Botulinum toxin or any other intervention at ALLOR:
- Retinal migraine
- Hemiplegic migraine
- Ophthalmoplegic migraine (recurrent painful ophthalmoplegic neuropathy)
- Vestibular migraine
- Abdominal or childhood migraine variants
- Secondary or vascular headache types (such as thunderclap headache, cough headache, postural hypotension headache, or headaches related to stroke or other structural causes)
These forms of migraine and headache require individualised evaluation and are best managed in consultation with your GP, a neurologist, or other specialist.
If you’re unsure which type of migraine you may be experiencing, or if your symptoms ever change suddenly, please seek medical attention promptly. For more support, you can also explore additional resources on our Migraine Resources page.
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