Headaches and Migraines
Recurring headaches can have many causes. Learn about migraine, cervicogenic and tension-type headaches, how they are assessed and when chiropractic treatment may be appropriate.
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Migraine Variants & Different Types of Migraine
Migraine does not always cause a typical severe headache. Symptoms can include visual disturbances, dizziness, sensory changes and, in some forms, neurological symptoms.
Migraine can present in many different ways. Some people experience a severe headache, while others may have visual disturbances, dizziness, numbness, speech symptoms or other neurological symptoms.
Understanding the pattern of symptoms is important because not every unusual headache, visual disturbance or episode of dizziness is caused by migraine, and some symptoms require medical investigation.
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Can You Have a Migraine Without a Typical Migraine Headache?
Yes. Migraine is a neurological condition and headache is only one possible part of a migraine attack.
Some people experience visual or sensory symptoms before a headache, some experience dizziness or balance symptoms, and some can experience migraine aura without developing a headache at all.
There are also less common forms of migraine that can cause symptoms such as temporary weakness, speech disturbance or other neurological symptoms.
Because these symptoms can sometimes resemble other medical conditions, particularly when they occur for the first time or are different from your usual migraine pattern, appropriate medical assessment can be important.
What Are the Different Types of Migraine?
Migraine does not present in exactly the same way in everyone. Even the same person may experience different symptoms from one attack to another.
The International Classification of Headache Disorders recognises several forms of migraine. The following are some of the types and presentations patients are most likely to encounter.
Migraine Without Aura
Migraine without aura is a common form of migraine. Attacks typically involve headache together with other migraine symptoms such as nausea or sensitivity to light and sound.
The headache is often moderate to severe and may be throbbing or pulsating. Physical activity can make symptoms worse.
Not everyone experiences every symptom, and migraine can vary considerably between individuals.
Migraine With Aura
Some people experience temporary neurological symptoms known as an aura before or during a migraine attack.
Visual aura is particularly common and may include:
- Flashing or shimmering lights
- Zig-zag patterns
- Blind spots or areas of altered vision
- Changes in the visual field
Aura can also involve sensory symptoms such as tingling or numbness, or temporary difficulties with speech or language.
A typical aura usually develops gradually and is fully reversible. Most individual aura symptoms last between 5 and 60 minutes.
Can You Have Migraine Aura Without a Headache?
Yes. Some people experience a typical migraine aura without developing a headache afterwards.
This is sometimes informally described as a “silent migraine”, although migraine with typical aura without headache is a more precise description.
Because visual or neurological symptoms without headache can sometimes have causes other than migraine, new or unusual symptoms should not automatically be assumed to be migraine.
Vestibular Migraine
Vestibular migraine is associated particularly with episodes of vertigo or dizziness and problems with spatial orientation or balance.
Symptoms can include:
- Vertigo or a sensation of movement
- Dizziness associated with head movement
- Motion sensitivity
- Nausea
- Sensitivity to visual movement
Headache does not necessarily occur during every episode.
There are many possible causes of dizziness and vertigo, so these symptoms require appropriate assessment rather than automatically being attributed to migraine.
Hemiplegic Migraine
Hemiplegic migraine is a rare form of migraine with aura that includes temporary motor weakness.
Other aura symptoms may include visual changes, sensory disturbances or problems with speech or language.
New weakness affecting one side of the body should never simply be assumed to be migraine. Symptoms resembling a stroke require urgent medical assessment, particularly if they are new or have not previously been medically investigated.
Migraine With Brainstem Aura
Migraine with brainstem aura is another uncommon form of migraine. It can involve combinations of neurological symptoms such as vertigo, tinnitus, double vision, problems with coordination or speech, and changes in consciousness.
The older terms “basilar migraine” and “basilar-type migraine” are no longer preferred.
Because these symptoms can overlap with other neurological conditions, appropriate medical assessment is important.
Can Children Have Migraines?
Yes. Migraine can occur in children and adolescents, although the pattern may not always look the same as migraine in adults.
Children may have headache, nausea, vomiting, sensitivity to light or sound and a desire to stop normal activities during an attack.
Recurring or unusual headaches in a child should be appropriately assessed rather than simply assumed to be migraine.
Why Is Identifying the Type of Migraine Important?
Different migraine presentations can produce very different symptoms.
Someone experiencing visual disturbances without headache, for example, may have a very different presentation from someone whose main symptoms are severe headache and nausea or someone experiencing recurrent vertigo.
Identifying the pattern helps determine whether symptoms appear consistent with migraine and whether medical investigation or referral may be appropriate.
What About Neck Pain and Migraine?
Neck pain and stiffness are commonly reported by people with migraine. In some people, neck symptoms may form part of the migraine attack itself, while others may also have a separate musculoskeletal neck problem.
Migraine is a neurological condition, but neck pain and stiffness can occur alongside it. Assessment can help distinguish symptoms associated with the migraine itself from a separate musculoskeletal neck problem.
Where assessment identifies a separate musculoskeletal problem involving the neck, appropriate treatment may be considered for those symptoms alongside the person’s wider migraine management.
Read more about migraine and chiropractic care →
When Should Migraine-Like Symptoms Be Assessed Urgently?
Many people experience recurring migraine symptoms that have previously been diagnosed and follow a familiar pattern. However, a new or substantially different headache or neurological symptom should not automatically be assumed to be migraine.
Seek urgent medical assessment for symptoms such as:
- A sudden, extremely severe headache
- New weakness or paralysis
- New difficulty speaking or understanding speech
- Loss of consciousness or significant confusion
- A new persistent loss of vision
- A severe headache following significant head injury
- Headache accompanied by severe illness, high fever or marked neck stiffness
If neurological symptoms are new, unusual or significantly different from your established migraine pattern, medical assessment is appropriate.
Frequently Asked Questions About Migraine Variants
Can you have a migraine without a headache?
Yes. Migraine aura can sometimes occur without a subsequent headache. New visual or neurological symptoms should nevertheless be appropriately assessed rather than automatically attributed to migraine.
Can migraine cause dizziness?
Yes. Vestibular migraine can cause episodes of vertigo, dizziness and motion sensitivity. However, there are many other causes of dizziness, so assessment is important.
Can migraine cause numbness or tingling?
Migraine aura can include temporary sensory symptoms such as tingling or numbness. New or unusual neurological symptoms require appropriate medical assessment.
Can migraine cause weakness?
Hemiplegic migraine can cause temporary motor weakness, but it is uncommon. New weakness can also indicate a medical emergency and should not simply be assumed to be migraine.
Are cluster headaches a type of migraine?
No. Cluster headache is a different type of primary headache disorder. Although some symptoms can overlap with migraine, it is classified separately and requires a different diagnostic approach.
Not Sure What Type of Migraine or Headache You Have?
Headaches and migraine symptoms can overlap, and you do not need to diagnose the problem yourself before seeking advice.
At Isis Chiropractic Centres, we can assess your headache history and associated musculoskeletal symptoms. Where symptoms suggest that medical investigation or referral is more appropriate, we will advise you accordingly.