Types of Migraines: Understanding the Key Differences

Written and verified by Holly Hazen

Not all migraines are the same. Understanding the different types of migraines and how they are classified is essential for accurate diagnosis, safer treatment decisions, and better long-term management.

Migraine is a neurological disease, not just a headache. The symptoms you experience whether visual disturbances, vertigo, weakness, abdominal pain, or prolonged attacks help determine which type you have.

Correct classification matters because:

• Some treatments work better for specific types

• Certain medications may not be recommended for rare variants

• Stroke-mimicking symptoms require careful evaluation

• Chronic patterns require different management strategies
  
  

Below we'll cover the major migraine types based on current ICHD-3 diagnostic classifications.

Main Types of Migraines (ICHD-3 Classification)

Migraine classification is based on the International Classification of Headache Disorders (ICHD-3), the diagnostic standard used by neurologists worldwide.

Under this system, migraine is divided into two primary categories:

Migraine Without Aura (MWOA)
Migraine With Aura (MWA)

Within these two categories are several subtypes and variants, some common and some rare.

Let’s break them down clearly.

1. Migraine Without Aura (MWOA)

Migraine without aura, sometimes called “common migraine”, is the most prevalent form affecting approximately 80–85% of people with migraine.

Core Features:

• Moderate to severe head pain (often one-sided)

• Pulsating or throbbing quality

• Nausea and/or vomiting

• Sensitivity to light (photophobia)

• Sensitivity to sound (phonophobia)
  
  

Although called “without aura,” many people still experience early warning symptoms such as fatigue, mood shifts, neck stiffness, or food cravings hours before pain begins (prodrome phase).

Subtypes of Migraine Without Aura

Chronic Migraine

Chronic migraine is diagnosed when:

• Headaches occur 15 or more days per month

• At least 8 of those days meet migraine criteria

• This pattern continues for more than 3 months
  
  

Chronic migraine is one of the most disabling forms and often requires preventive treatment strategies.

→ Learn more: Chronic Migraine

Abdominal Migraine

Most common in children, abdominal migraine presents as:

• Recurrent abdominal pain

• Nausea and vomiting

• Pallor

• No significant head pain
  
  

Many children with abdominal migraine later develop typical migraine with or without aura.

→ Learn more: Abdominal Migraine

Status Migrainosus (Intractable Migraine)

Status migrainosus refers to a migraine attack lasting 72 hours or longer despite treatment.

Key characteristics:

• Prolonged, severe pain

• Persistent nausea or vomiting

• Often requires medical intervention
  
  

This condition does not increase stroke risk simply due to “dilated blood vessels” — migraine is now understood as a neurovascular disorder involving complex brain signaling changes rather than purely vascular dilation.

Status migrainosus requires structured medical care.

2. Migraine With Aura (MWA)

Migraine with aura affects approximately 25% of people with migraine.

Aura consists of temporary neurological symptoms that usually occur before the headache phase, though they can occur during or even without pain.

Common Aura Symptoms:

• Flashing lights
  

• Zigzag lines

• Blind spots

• Numbness or tingling

• Speech disturbances
  
  

Aura typically develops gradually and lasts 5–60 minutes.

Migraine with aura is associated with a slightly increased risk of stroke, particularly in individuals who smoke or use estrogen-containing contraceptives. This is why proper diagnosis matters.

If you’re unsure whether your symptoms are migraine or something more serious, read Migraine with Stroke Like Symptoms: Recognize, Respond, and Stay Safe.

Migraine with Aura Variants

Vestibular Migraine

Vestibular migraine is characterized by:

• Vertigo

• Motion sensitivity

• Balance disruption

• Nausea

• Light sensitivity
  
  

Head pain may or may not be present.

It is frequently mistaken for inner ear disorders.

→ Learn more: Vestibular Migraine

Migraine with Brainstem Aura

(formerly Basilar-Type Migraine)

This rare form includes aura symptoms originating from the brainstem:

• Dizziness

• Double vision

• Speech difficulties

• Ringing in the ears

• Balance problems

• Confusion
  
  

Motor weakness is not present in this type.

Symptoms usually last less than one hour and are followed by migraine pain.

Hemiplegic Migraine

Hemiplegic migraine is a rare and more severe variant.

It includes:

• Temporary weakness or paralysis on one side of the body

• Sensory disturbances

• Speech difficulty

• Stroke-like symptoms
  
  

Because symptoms mimic stroke, urgent evaluation is required during first episodes to rule out vascular causes.

Triptans are generally avoided unless directed by a specialist.

There is often a genetic component.

Retinal Migraine

Retinal Migraine involves temporary visual disturbance or vision loss in one eye only. Because vision loss in one eye can signal a vascular issue affecting the retina, medical evaluation is always required to rule out more serious causes. I'll cover this one more in the next section.

Migraine Types Affecting Vision and Eye Muscles

Retinal Migraine (One-Eye Visual Disturbance)

Retinal migraine involves:

• Temporary visual loss or disturbance in one eye only

• Temporary blindness possible

• Visual symptoms lasting minutes to an hour

• Often followed by headache on the same side

• Needs medical evaluation

• Different from aura affecting both eyes
  
  

True retinal migraine is rare and should always be evaluated to rule out other eye conditions.

Ocular, Optical & Ophthalmic Migraine (Non-Clinical Terms)

Confusion often arises around these informal labels, which are not official ICHD-3 diagnostic categories.

Ocular Migraine

Ocular Migraine is commonly used to describe visual aura symptoms affecting both eyes. It is not a formal medical diagnosis but an informal term people use for flashing lights, zigzag lines, or blind spots that typically resolve within an hour.

Optical Migraine

A non-clinical term typically referring to visual disturbances. Similar to ocular migraine, optical migraine involves visual disturbances like flashes or patterns but may include mild head discomfort. The visual effects are usually seen in both eyes and often fade quickly.

Ophthalmic Migraine

Sometimes used broadly for migraine involving visual symptoms. It can affect eye movement or cause light sensitivity. It sometimes overlaps with descriptions of Ophthalmoplegic Migraine, now renamed RPON.

These terms are not formal diagnostic categories under ICHD-3.

Recurrent Painful Ophthalmoplegic Neuropathy (RPON)

Formerly called “ophthalmoplegic migraine,” RPON is now classified as a rare cranial neuropathy rather than a migraine subtype.

Symptoms include:

• Pain behind one eye

• Drooping eyelid (ptosis)

• Double vision

• Weakness of eye muscles
  
  

If eye muscle paralysis occurs, immediate medical evaluation is required to rule out aneurysm or other structural causes.

When To Seek Emergency Care

Seek urgent medical attention if you experience:

• A sudden “worst headache of your life”

• First severe migraine attack

• New paralysis or weakness

• Persistent speech difficulty

• Sudden vision loss

• Confusion or altered consciousness

• Headache following head injury
  
  

Some migraine types can mimic serious neurological conditions such as stroke. When symptoms differ from your usual pattern, err on the side of caution.

Why Proper Migraine Classification Matters

Accurate identification helps:

• Guide medication choices

• Determine need for preventive therapy

• Reduce misdiagnosis

• Avoid inappropriate treatments

• Improve long-term management
  
  

Migraine is highly individualized. Understanding your specific type allows for more targeted and effective care.

Each year, leading neurologists discuss migraine classification and treatment advances during the Migraine World Summit.

Common Questions About Types of Migraines

Click on the arrow for the answer to display.

Final Thoughts

Migraine is not one condition — it is a spectrum of neurological presentations.

Whether you experience migraine without aura, migraine with aura, chronic migraine, vestibular symptoms, or a rare subtype, correct diagnosis and classification is the first step toward better pain and symptom management.

Use this information to have informed conversations with your healthcare provider.

And remember, diagnosis comes from a physician and not from self-labeling alone.

Further Reading on Migraine Types

Core Migraine Classifications

• 4 Phases of Complex Migraine

• What Are Migraines From?

• Migraine vs Headache: Understanding the Critical Differences 
  
  

Migraine Without Aura & Chronic Patterns

• Chronic Migraines: Not Life Threatening, Just Life Altering!

• How To Keep Daily Migraines from Ruining Your Life

• Severe Migraines: The Most Complicated Types of Headache

• What Helps Stomach Migraines? 

• Are Abdominal Migraines Just An Excuse To Leave School?
  
  

Migraine With Aura Variants

• 6 Steps to Deal with Optical Migraine

• Opthalmic Migraine: Risks, Symptoms, And Easy Relief

• Top Tips to Deal with Ocular Migraines

• Painless Migraine: How To Manage Them More Effectively
  

• 7 Tips for Coping with Silent Migraine
  
  

Hormonal & Special Patterns

• What’s The Best Way To Stop Hormonal Migraines?
  
  

Differentials & Misdiagnosis

• Is It Sinus or Migraine? How to Identify and Treat Symptoms Correctly

• What Is a Cluster Migraine? Symptoms, Signs & Relief
  

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_{Types of Migraines Page Source:
Classification information is based on the International Classification of Headache Disorders (ICHD-3).}

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