Complicated migraine: overview and more

Migraines are common and affect around 10% of the world’s population. These throbbing headaches are usually located on one side of the head and may be accompanied by an aura. A migraine aura precedes a headache and is associated with visual, sensory and/or speech disturbances that last up to an hour.

The term “complicated migraine” is outdated and no longer used in the medical community. Although there has been no clear consensus on the exact definition of the term, “complicated migraine” has historically been used by healthcare providers to describe migraine with aura and/or migraines associated with symptoms prolonged or atypical auras.

This article will review the symptoms, diagnosis, and treatment of two subtypes of migraine associated with prolonged or atypical aura symptoms. These rare subtypes were perhaps considered “complicated” in the past.

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Symptoms

The aura symptoms of a typical migraine with aura are fully reversible, occur on only one side of the body or visual field, and usually last no more than an hour.

These symptoms include:

  • Visual symptoms: See bright spots or zigzag lights
  • Sensory symptoms: Numbness or tingling that develops on one side of the face or spreads down one arm
  • Speech symptoms: Difficulty finding words or scrambling for words

Hemiplegic migraine

Hemiplegic migraine is a rare and quite dramatic subtype of migraine with aura.

He may have been considered “complicated” because his aura consists of a weakness on one side of the body. This weakness usually lasts less than 72 hours but may persist for weeks in some patients.

Besides weakness, people with hemiplegic migraine also tend to experience typical aura symptoms (eg visual, sensory and/or speech disturbances).

Migraine with brainstem aura

Migraine with brainstem aura (MBA) – formerly known as basilar-type migraine – may have been considered “complicated” because its aura symptoms are unusual and can last for several hours or even days in some patients.

Symptoms include:

  • Double vision
  • Vertigo, or a spinning sensation
  • Tinnitus (ringing in the ears)
  • Hypersensitivity to sound
  • Speech disorders
  • Weakness and numbness on both sides of the body
  • Fainting or loss of consciousness

causes

A typical migraine with aura is caused by a phenomenon called cortical spreading depression (CSD).

What is CDD?

With CSD, waves of altered brain activity travel throughout the brain (cortex), causing changes in nerve cell responses and blood flow.

Hemiplegic migraine

Hemiplegic migraine also results from CSD occurring in the cortex. Additionally, various genetic mutations (changes in the DNA sequence) have been linked to hemiplegic migraine.

Depending on how these genetic mutations are obtained, hemiplegic migraine is divided into two different types, as follows:

  • Familial hemiplegic migraine is hereditary, which means that any genetic mutation is passed on to family members.
  • Sporadic hemiplegic migraine is less common and is not hereditary, which means that genetic mutations occur randomly.

Migraine with brainstem aura

Migraine with brainstem aura involves two or more symptoms that originate in the brainstem (eg, vertigo, tinnitus, and double vision).

Interestingly, despite its old name, there is no evidence that the basilar artery (located at the base of the skull) is involved in this unique type of migraine.

Diagnostic

To diagnose any type of migraine, a neurologist (a doctor who specializes in nervous system disorders) will take a detailed medical and family history and perform a neurological exam.

If the neurological exam is abnormal, an electroencephalogram (EEG) (electrodes detect brain activity) and imaging tests, including magnetic resonance imaging (MRI) of the brain and its blood vessels, will also usually be practice.

The purpose of these diagnostic tests is to rule out conditions mimicking or conditions considered a “complication” of a migraine.

These conditions include:

Treatment

Mild to moderate migraine with aura are often relieved with nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen sodium), while more severe migraines with auras often require a triptan, such as Imitrex (sumatriptan), or an NSAID/triptan combination such as Treximet (sumatriptan and naproxen sodium).

For people who cannot take or tolerate a triptan, a calcitonin gene-related peptide (CGRP) blocker can be tried.

people with hemiplegic migraine and migraine with brainstem aura are usually treated with an NSAID. Triptans are generally avoided.

To face

Coping with any migraine disorder can be daunting and difficult. The upside is that simple strategies can help you improve your quality of life and navigate your diagnosis well.

These strategies may include:

  • Keep a diary: Record your daily or weekly thoughts, worries and goals. This can help you sort out the steps you need to take to best manage your migraines and help you feel more in control.
  • Find a headache specialist: Ask your primary care doctor or neurologist for a referral, or use a resource like the American Migraine Foundation.
  • Ask for support: Reach out to loved ones, online support networks, or a therapist for emotional guidance and reassurance.
  • Adopt a healthy lifestyle: Eat well, exercise daily, and stick to a regular sleep schedule. These habits can help prevent migraines and make you feel better overall.

Summary

Although an obsolete term, “complicated migraine” historically referred to migraine with aura and/or migraines associated with prolonged or atypical aura symptoms. The latter is observed in hemiplegic migraine and migraine with aura of the brainstem.

A word from Verywell

If you or a loved one has been diagnosed with hemiplegic migraine or migraine with brainstem aura, be sure to consult a headache specialist who is experienced in managing these rare subtypes of migraine. Together, you and your healthcare provider can develop a treatment plan that is safe, effective, and fits well into your daily routine.

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