What to know about atypical migraine

 Atypical migraine describes a migraine-like attack that does not follow the four-phase pattern of a typical migraine attack. Additionally, the condition may not meet all the diagnostic criteria for typical migraine.

It is important to note that “atypical migraine” is not an official medical term, and it is not listed in the International Classification of Headaches Disorders third edition (ICHD3).

However, research suggests that an atypical migraine attack may lastTrusted Source for a shorter duration or less frequently than a typical migraine. A person with atypical migraine may not experience any of the symptoms of a typical migraine, such as nausea, vomiting, and sensitivity to light or sound.

In this article we discuss the symptoms, causes, diagnosis, and treatment of atypical migraine, as well as when to speak with a doctor.

Symptoms

Research suggests that the symptoms of an atypical migraine attack may not always be the same as those of a typical migraine attack. Additionally, they may not follow the four phasesTrusted Source of a typical migraine attack or fulfill all of the diagnostic criteria listed in the ICHD3.

Atypical migraine may also present any of the following symptomsTrusted Source:

• Gastrointestinal issues such as diarrhea, vomiting, and abdominal bloating.
• Symptoms of benign paroxysmal positional vertigo, which may include dizziness, difficulty maintaining balance, and a feeling that any immediate surroundings are moving or spinning.
• Sensory and visual issues without any headache present, which healthcare professionals may refer to as typical aura without headache.
• Prodromal symptoms, which may include:
  • a stiff neck
  • fluid retention
  • euphoria
  • blurry vision
  • difficulty concentrating
  • yawning and difficulty swallowing
  • feelings of restlessness
  • sensitivity to light
  • aggression
• Autonomic symptomsTrusted Source, which may involve:
  • conjunctivitis
  • stuffy or runny nose
  • facial sweating
  • flushing of the face
  • a feeling of pressure in the ear
  • eyelid drooping
  • pinpoint pupils
• Recurring headache episodes that immediately interrupt activity, but a person is able to return to that activity as soon as the headache passes.
• Recurring headache episodes that interrupt sleep.

Typical vs. atypical migraine symptoms

Atypical migraine symptoms can present in areas of the body not typically associated with migraine. Some examples of these symptoms include vertigo, trouble swallowing, and nasal congestion. A person may not even present with any headache pain.

Healthcare professionals define typical migraine as repeated episodes of throbbing and pulsating pain on one side of the head. Other common typical migraine symptoms can include:

• nausea
• sensitivity to noise, light, and smell
• vomiting

Additionally, typical migraine has four phases, which include:

• Prodrome: These are symptoms a person experiences up to 24 hoursTrusted Source before a migraine attack. They may include uncontrollable yawning, unexplained changes in mood, and food cravings.
• Aura: These symptoms may occur prior to or during the migraine attack. They may include muscle weakness and visual disturbances, such as flashing or bright lights.
• Headache: This may develop gradually and become more intense during the attack.
• Postdrome: During this phase, a person may feel confused or exhausted following the attack.

Potential causes and triggers

Causes and risk factors for atypical migraine may includeTrusted Source having a family history of atypical or typical migraine, or episodic neurological symptoms earlier in life.

In some cases, a person may notice that certain factors trigger atypical migraine attacks. Some examples may include:

• drinking alcohol
• consuming too much caffeine, or experiencing caffeine withdrawal
• skipping meals
• exercising
• eating certain foods or additives
• not getting enough sleep
• stress
• smoking
• experiencing hormonal changes, which may be due to the menstrual cycle or taking oral contraceptives
• strong smells or perfume
• changes in the weather, or certain types of weather

Diagnosis 

If a person is experiencing migraine-like attacks that do not follow the typical four phases of a migraine attack or do not present the common symptoms of a typical migraine, then a doctor may diagnose them with atypical migraine.

According to a 2022 article, a doctor may diagnoseTrusted Source someone with atypical migraine if the attacks are missing two of the diagnostic criteria associated with a typical migraine, or if they do not follow the typical phases of migraine.

A healthcare professional may also ask someone about their personal and family medical history and perform a physical examination to rule out any other causes of the symptoms.

Treatment

Treatment for atypical migraine may involveTrusted Source identifying triggers and avoiding them if possible.

Immediate tips that may help relieve symptoms during an atypical migraine attack include:

• drinking plenty of fluids, especially if a person is vomiting
• resting or napping with the eyes closed in a dark and quiet room
• placing a cold compress on the forehead

A doctor may also recommend medications to help relieve symptoms. Some of these may includeTrusted Source:

• nonsteroidal anti-inflammatory drugs (NSAIDs)
• acetaminophen
• dopamine receptor antagonists
• triptans
• ditans and gepants

There are also several medicationsTrusted Source available that may prevent atypical migraine attacks before they occur such as beta blockers.

A person should speak with a healthcare professional about which treatments for atypical migraine may work best for them.

When to speak with a doctor

If a person is experiencing symptoms of atypical migraine such as vertigo, autonomic symptoms, and recurring headache episodes, they should contact a doctor who can help work out the underlying cause of the symptoms.

A person with a diagnosis of atypical migraine may findTrusted Source that their treatment plan is not proving to be effective. Should this be the case, a person should contact a doctor to review the steps of the treatment plan, any medications, and if there are alternative steps a person can take to help treat the condition.

People may find it helpful to make a headache or migraine attack diary to help log their symptoms, triggers, and treatment methods. This may help them and their doctor work out if any different treatment approaches are necessary.

Summary

Atypical migraine does not follow the four-phase pattern of a typical migraine, or it may not meet the ICHD3 migraine diagnostic criteria.

A person with atypical migraine may experience several symptoms that are not usually present with typical migraine, such as vertigo, aura without headache, and nasal congestion.

To treat the condition, a doctor may recommend a person avoids any known triggers for atypical migraine attacks. A doctor may also prescribe medications, such as NSAIDs and triptans, to help with symptoms.

A person should contact a healthcare professional if they are experiencing any atypical migraine symptoms, or if any current treatments a doctor has recommended do not seem to be helping with their symptoms.

Source - Medical News Today