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What Is a Complex or Complicated Migraine?

by Teri Robert, Lead Expert

People often ask what "complex Migraines" or "complicated Migraines are." That's a difficult question to answer because it varies depending on who's using those terms.

In most areas of medicine, terminology and diagnostic classifications are standardized so that diagnoses are uniform and when one is mentioned, logical discussion or search for information can follow. That applies in the field of what's generally called "headache medicine," the diagnosis and treatment of Migraine and other headache disorders, as well. The International Headache Society's International Classification of Headache Disorders, 2nd Edition, (ICHD-II) is the gold standard for diagnosing and classifying headache disorders.

Under ICHD-II, there is no classification of "complex" on "complicated" Migraine. Sometimes, "complex" or "complicated" are used as descriptive terms, as opposed to diagnoses, to describe a Migraine attack that is more complex or complicated than they consider to be "normal" or "average." If you hear or see someone using those terms meaning them to be diagnoses of a particular form of Migraine, it's quite difficult to know what they really mean. Since there's no defined criteria or reference for either of them as forms of Migraine, what one person means may be very different from what another person means.

It's helpful to know the types of Migraine that are recognized in the ICHD-II. They are:

1.1 Migraine without aura

1.2 Migraine with aura

1.2.1 Typical aura with migraine headache
1.2.2 Typical aura with non-migraine headache
1.2.3 Typical aura without headache
1.2.4 Familial hemiplegic migraine (FHM)
1.2.5 Sporadic hemiplegic migraine
1.2.6 Basilar-type migraine       

1.3 Childhood periodic syndromes that are commonly precursors of migraine

1.3.1 Cyclical vomiting
1.3.2 Abdominal migraine
1.3.3 Benign paroxysmal vertigo of childhood

1.4 Retinal migraine

1.5 Complications of migraine

1.5.1 Chronic migraine
1.5.2 Status migrainosus
1.5.3 Persistent aura without infarction
1.5.4 Migrainous infarction
1.5.5 Migraine-triggered seizures

1.6 Probable migraine

1.6.1 Probable migraine without aura
1.6.2 Probable migraine with aura
1.6.5 Probable chronic migraine

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