Table of ContentsView AllTable of ContentsSymptoms and TypesCausesDiagnosisTreatmentCoping
Table of ContentsView All
View All
Table of Contents
Symptoms and Types
Causes
Diagnosis
Treatment
Coping
This article will review the symptoms, diagnosis, and treatment of two migraine subtypes 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 one hour.
These symptoms include:
Hemiplegic Migraine
Hemiplegic migraineis a rare, quite dramatic subtype of migraine with aura.
It may have been considered “complicated” because its aura consists of 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 (e.g., visual, sensory, and/or speech disturbances).
Migraine With Brain Stem Aura
Migraine with brain stem aura (MBA)—previously known as basilar-type migraine—may have been considered “complicated” because its aura symptoms are unusual and can last for several hours, even days, in some patients.
Symptoms include:
What Is CSD?With CSD, waves of altered brain activity spread throughout the brain (cortex) resulting in changes in nerve cell responses and blood flow.
What Is CSD?
With CSD, waves of altered brain activity spread throughout the brain (cortex) resulting in changes in nerve cell responses and blood flow.
Hemiplegic migraine also results from CSD occurring in the cortex.In addition, various genetic mutations (changes in DNA sequence) have been linked to hemiplegic migraine.
Depending on how these genetic mutations are obtained, hemiplegic migraine is further divided into two different types, as follows:
Migraine with brain stem aura involves at least two symptoms that originate within thebrain stem(e.g., vertigo, tinnitus, and double vision).
Interestingly, despite its previous name, there is no evidence that thebasilar artery(located at the base of the skull) is involved in this unique type of migraine.
To diagnose any type of migraine, aneurologist(a doctor who specializes in disorders of the nervous system) will take a detailed medical and family history and perform aneurological exam.
If the neurological exam is abnormal, anelectroencephalogram (EEG)(electrodes detect brain activity) and imaging tests, notablymagnetic resonance imaging (MRI) of the brainand its blood vessels, will also usually be performed.
The purpose of these diagnostic tests is to rule out mimicking conditions or conditions considered a “complication” of a migraine.
Such conditions include:
Mild to moderatemigraine with aurasare often relieved withnonsteroidal anti-inflammatory drugs (NSAIDs)like Advil (ibuprofen) or Aleve (naproxen sodium), whereas more severe migraines with auras often require atriptan, like Imitrex (sumatriptan), or a combination NSAID/triptan like Treximet (sumatriptan and naproxen sodium).
For people who cannot take or tolerate a triptan, a calcitonin gene-related peptide (CGRP) blocker, likeZavzpret (zavegepant), may be tried.
People withhemiplegic migraineandmigraine with brainstem auraare usually treated with anNSAID.Triptans are generally avoided.
Coping with any migraine disorder can be daunting and challenging. The upside is that simple strategies can help you improve your quality of life and navigate your diagnosis well.
These strategies may include:
Summary
Although an outdated term, “complicated migraine” historically referred to migraine with aura and/or migraines associated with prolonged or atypical aura symptoms. The latter is seen in hemiplegic migraine and migraine with brain stem aura.
A Word From Verywell
If you or a loved one has been diagnosed with hemiplegic migraine or migraine with brain stem aura, be sure to see a headache specialist who has experience managing these rare migraine subtypes. Together, you and your healthcare provider can build a treatment plan that is safe, effective, and fits well within your daily routine.
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Woldeamanuel YW, Cowan RP.Migraine affects 1 in 10 people worldwide featuring recent rise: A systematic review and meta-analysis of community-based studies involving 6 million participants.J Neurol Sci.2017;372:307-315. doi:10.1016/j.jns.2016.11.071
National Headache Foundation.Complicated migraine.
American Migraine Association.Understanding migraine with aura
International Headache Society.Hemiplegic migraine.
International Headache Society.Migraine With Brainstem Aura.
Cui Y, Kataoka Y, Watanabe Y.Role of cortical spreading depression in the pathophysiology of migraine.Neurosci Bull. 2014;30(5):812-22. doi:10.1007/s12264-014-1471-y
National Center for Advancing Translational Sciences.Familial or sporadic hemiplegic migraine.
Pelzer N, Stam AH, Haan J, Ferrari MD, Terwindt GM.Familial and sporadic hemiplegic migraine: diagnosis and treatment.Curr Treat Options Neurol. 2013 Feb;15(1):13-27. doi:10.1007/s11940-012-0208-3
Ong JJY, De Felice M.Migraine treatment: current acute medications and their potential mechanisms of action[published correction appears inNeurotherapeutics. 2018 Jan 8;:].Neurotherapeutics. 2018;15(2):274-290. doi:10.1007/s13311-017-0592-1
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