Before we can begin to address and treat our migraines, we need a complete and accurate diagnosis. A simple diagnosis of “migraine” that doesn’t specify which form or forms of migraine we have is not a complete diagnosis. A complete and accurate migraine diagnosis is important for several reasons, including:
- Triptan and ergotamine migraine abortive medications are contraindicated for hemiplegic migraine and migraine with brainstem aura.
- Some of the possible symptoms of migraine also can be symptoms of stroke and other health issues. Some of them occur only in certain types of migraine, and that can be helpful in determining if a symptom is attributable to a migraine or if immediate medical care is appropriate. One example of this is the hemiplegia that can occur during a hemiplegic migraine. If hemiplegia occurs in a patient who has not been diagnosed with hemiplegic migraine and experienced that symptom before, they should seek immediate medical care.
- If we need to seek medical care from someone other than our regular doctor, knowing an accurate diagnosis can be vital.
Confusion can occur when people, including some doctors, use the names for the types of migraines inconsistently or incorrectly. This can occur in any field of medicine, and there’s generally a document that standardizes diagnoses. In the field of “headache medicine,” the International Headache Society’s International Classification of Headache Disorders (ICHD) is the gold standard for diagnosing and classifying migraine and other headache disorders. The ICHD is now in its third edition, ICHD-3.
Here’s a listing of forms of migraine as outlined in ICHD-3. Some of them are links to more information on that form of migraine:
1.2.1 Migraine with typical aura
126.96.36.199 Typical aura with headache
188.8.131.52 Typical aura without headache
1.2.3 Hemiplegic migraine
184.108.40.206 Familial hemiplegic migraine (FHM)
220.127.116.11.1 Familial hemiplegic migraine type 1
18.104.22.168.2 Familial hemiplegic migraine type 2
22.214.171.124.3 Familial hemiplegic migraine type 3
126.96.36.199.4 Familial hemiplegic migraine, other loci
188.8.131.52 Sporadic hemiplegic migraine
1.2.4 Retinal migraine
1.3 Chronic migraine
1.4 Complications of migraine
1.4.1 Status migrainosus
1.4.3 Migrainous infarction
1.5 Probable migraine
1.5.1 Probable migraine without aura
1.5.2 Probable migraine with aura
1.6 Episodic syndromes that may be associated with migraine
1.6.1 Recurrent gastrointestinal disturbance
184.108.40.206 Cyclical vomiting syndrome
220.127.116.11 Abdominal migraine
1.6.2 Benign paroxysmal vertigo
1.6.3 Benign paroxysmal torticollis
A1.6.5 Vestibular migraine (ICHD-3 recognizes vestibular migraine for the first time in its appendix. Diagnoses listed in the ICHD appendix are often moved into the main body of the document in the next edition.
If you’ve been given an incomplete diagnosis of “migraine,” or if the diagnosis you’ve been given doesn’t appear in the list above, talk to your doctor. One issue that can lead to this is the lack of training about migraine and other headache disorders in medical schools. If your doctor can’t provide you with a complete and accurate diagnosis, remember that there’s nothing wrong with getting a second opinion. You may want to check with a migraine specialist. It’s important to note that neurologists aren’t necessarily migraine specialists. For more information about migraine specialists and how to locate one, please see Why, How, and Where to Find a Migraine Specialist.
More helpful articles:
Headache Classification Committee of the International Headache Society. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. July 2013 vol. 33 no. 9 629-808. 10.1177/0333102413485658.
Teri Robert is a leading patient educator and advocate and the author of Living Well with Migraine Disease and Headaches. A co-founder of the Alliance for Headache Disorders Advocacy and the American Headache and Migraine Association, she received the National Headache Foundation’s Patient Partners Award and a Distinguished Service Award from the American Headache Society. Teri can be found on her website, and blog, Facebook, Twitter, StumbleUpon, Pinterest, LinkedIn, and Google+.