What are the types of migraine?

Hemiplegic migraine

This is a rare form of migraine during which you experience weakness on one side of the body (hemiplegia) along with the migraine headache. The weakness is a form of migraine aura. The weakness may last for hours to days or rarely weeks and in most it resolves completely. There may be other aura symptoms present such as tingling in the arm or leg, speech difficulties or zig-zags in vision. In general these symptoms occur in succession. The diagnosis of a hemiplegic migraine is quite difficult as the symptoms may mimic a stroke. Therefore, it is imperative that you would seek medical attention if this happens to you and you do not have a prior diagnosis of hemiplegic migraine. You will need brain imaging to rule out a more serious cause of the weakness (such as stroke) before your doctor can make the diagnosis of a hemiplegic migraine- even if there is an accompanying headache. In general, once it is diagnosed it is managed like any other form of migraine.

Vestibular migraine

In the vestibular system, the inner ear sends sensory signals to the brain that help coordinate eye movements to regulate the sense of balance and spatial position- in vestibular migraine (VM) this mechanism is out of kilter. There is a mismatch between the sensory signals and the eye movements which creates the feeling that objects are moving when they are not- which is what is known as vertigo.

VM is actually a very common form of migraine.  The main symptom of a VM is vertigo. There may or may not be a headache in association with the vertigo symptoms. When there is a headache the vertigo symptoms can occur before, during or after the headache.  The vertigo episodes can last from 5 minutes to 72 hours. It can also be associated also with nausea and vomiting as well as balance problems. The dizziness is often triggered by moving your head or eyes.

The treatment involves a combination of medication, vestibular rehabilitation and lifestyle modifications. The medication used will depend on the main symptom present. In some patients the usual migraine medications may be beneficial. In others anti-vertigo and anti-nausea medications may help. Vestibular rehabilitation is designed to retrain the brain and vestibular system to allow them to work in sync again. This should begin with an assessment by a physiotherapist or doctor who is trained in administering this form of rehabilitation and then can be safely continued at home through approved exercise programmes.