As if migraines aren't big enough mischief-makers as it is, they also like to sing show tunes and take on different personas. So here we turn to migraine variants — the exceptions and odd lots that make finding your way to migraine diagnosis and treatment quite a challenging proposition.
Abdominal migraines
Abdominal migraines, which are sometimes diagnosed in children, are unusual because they cause pain in the stomach and lead to nausea and vomiting (sometimes without a headache).
A child who complains of recurrent pain in his stomach may be experiencing abdominal migraines. Children who suffer from abdominal migraines are likely to have migraine headaches in adulthood. Abdominal migraines are usually treated with anticonvulsant drugs.
Basilar migraines
The basilar migraine was once known as the basilar artery migraine, or BAM. It was considered a problem that was found primarily in young women and adolescent girls, but it occurs in both sexes and all ages. Basilar migraines are extremely rare, but they have the potential to be a serious health hazard in that they can lead to a transient ischemic attack (TIA) or stroke.
Symptoms to watch for are double vision, partial vision loss, terrible vomiting, dizziness, loss of balance, slurred speech, lack of coordination, numbness (on one or both sides of the body), weakness, and confusion. These symptoms typically go away at the onset of the actual headache, although they may last for days after the pain disappears.
If you experience any of the symptoms that signal basilar migraines, see a doctor as soon as possible.
Transient ischemic attacks, which can result from basilar migraines (although they rarely do), are essentially "mini-strokes." TIAs result from disruptions of the blood flow to the brain. Although a stroke can mean permanent disability, TIAs don't cause lasting damage. Any neurologic problems associated with TIAs, such as weakness in one arm and slurred speech, are resolved within 24 hours.
Hemiplegic migraines
Hemiplegic migraines are often caused by an inherited gene, but they occur in people with no family history of migraines. With hemiplegic migraines, you experience temporary paralysis or arm and leg weakness on one side of your body. The paralysis or weakness is then followed, usually within an hour, by bad head pain. The paralysis or weakness does not always go away when the headache disappears. These headaches often originate during childhood.
Ocular migraines
Ocular migraines are rare migraines that feature a repeated vision disturbance (temporary, partial, or complete vision loss in one eye) that lasts less than one hour. After the vision disturbance subsides, you're left with a dull ache behind the affected eye, and your entire head may ache, as well.
If you suffer from ocular migraines, you need to be evaluated by a doctor (an ophthalmologist) to exclude other possible causes for your vision loss.
Ophthalmoplegic migraines
Ophthalmoplegic migraines are no longer believed to be migraines. They are now thought to be a type of neuritis (inflammation of a nerve). These headaches are associated with pain around the eyeball and the temporary weakness or paralysis of eye muscle(s). It's a condition that's usually diagnosed in children. The common symptoms of these migraines are a drooping eyelid, a dilated pupil, and double vision.
Ophthalmoplegic migraines, which can last for days or months, require a thorough exam and testing to rule out conditions that are more serious.
Status migrainosus
The term status migrainosus refers to a migraine attack that goes on for more than 72 hours and leads to problems such as dehydration.
If you have status migrainosus, you should go to the emergency room, where you will be treated with IV fluids and pain medication.
Women-only migraines
Certain migraines are uniquely attached to the hormonal swings that females experience. Migraines are commonly linked to menstruation. Some women get migraine headaches when they're on oral contraceptives. And in the case of women who are going through or are past menopause, hormone therapy migraines can be problematic. (Some older women have hormone-replacement-therapy-related headaches, while other women who have had migraines in the past no longer have them after menopause.)
