Migraine without Aura: The Essentials

Migraine is a genetic neurological disease with several types and subtypes. An accurate and complete diagnosis is essential for proper treatment. For consistency in diagnosing and classifying head pain disorders, the International Headache Society’s International Classification of Headache Disorders, 3rd Edition (ICHD-3), is generally accepted as the “gold standard.” This provides standardization of diagnoses, providing guidance and reducing confusion.

Due to there being several  different types of migraine, and some forms involving different genetic markers, some researchers theorize that it may actually be more than one disease. For now, however, under ICHD-3, Migraine is divided into two major subtypes, Migraine without Aura (MWOA) and Migraine with Aura (MWA). There is a single classification under Migraine without Aura, which is the most common form of Migraine.

The three phases of a Migraine without Aura attack:

• The Prodrome
  The prodrome (sometimes called preheadache or premonitory phase) may be experienced hours or even days before a Migraine attack. The prodrome may be considered to be the Migraine patient’s “yellow light,” a warning that a migraine is imminent. For the 30 to 40 percent of Migraine patients who experience prodrome, it can be very helpful because it allows them to know a Migraine is coming. For Migraine patients who experience prodrome, it makes a solid case for keeping a Migraine diary and being aware of one’s body.
• The Headache
  The headache phase is generally the most debilitating part of a migraine attack. It’s effects are not limited to the head only, but affect the entire body. The pain of the Headache can range from mild to severe. It can be so intense that it is difficult to comprehend by those who have not experienced it. There are many possible symptoms of the Headache phase. A Migraine without aura attack can skip the Headache phase. In that case, it’s described as “acephalgic” or “silent” Migraine without Aura; the diagnosis is still Migraine without aura.
• The Postdrome
  Once the Headache phase is over, the Migraine attack may or may not be over. The postdrome (sometimes called postheadache) follows immediately afterward. The majority of people with Migraine take hours to fully recover, some take days. Many people describe postdrome as feeling “like a zombie” or “hung-over.” These feelings are often attributed to medications taken to treat the Migraine, but may well be caused by the Migraine itself. In cases where prodrome and/or aura are experienced without the Headache phase, the postdrome may still occur.

Some differences in children

• In children and adolescents (under 18) attacks may last 2-72 hours.
• The headache of a Migraine attack is commonly bilateral in young children; an adult pattern of unilateral pain usually emerges in late adolescence or early adulthood.
• In young children, photophobia and phonophobia may be inferred from observing their behavior.
• The headache of a Migraine attack is usually frontotemporal (front and sides, toward the front, of head). Occipital (lower back of the head) Headache in children, whether unilateral or bilateral, is rare and calls for caution in diagnosing as many cases are attributable to structural lesions.
• It’s important to note that we can have more than one type of Migraine. It’s also not unusual to experience both Headaches and Migraines. In fact, Tension-Type Headaches can be a migraine trigger.

ICHD-3 Classification of Migraine without aura

1.1 Migraine without aura

Previously used terms:

Common migraine, hemicrania simplex

Description:

Recurrent headache disorder manifesting in attacks lasting 4-72 hours. Typical characteristics of the headache are unilateral location, pulsating quality (throbbing or varying with the heartbeat), moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.

Diagnostic criteria:

1. At least 5 attacks fulfilling criteria B-D
2. Headache attacks lasting 4-72 hours (untreated or unsuccessfully treated)
3. Headache has at least two of the following characteristics:
   1. unilateral location
   2. pulsating quality
   3. moderate or severe pain intensity
   4. aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
4. During headache at least one of the following:
   1. nausea and/or vomiting
   2. photophobia and phonophobia
5. Not better accounted for by another ICHD-3 diagnosis.

Remember!

If your doctor has diagnosed you with “Migraines,” ask for a more definitive diagnosis. That will make it easier for you to find information and learn about Migraine disease as it applies to you. It will also be very helpful if you ever need to seek care from a different doctor.

Sources:

1. Headache Classification Committee of the International Headache Society. “The International Classification of Headache Disorders, 3rd Edition (ICHD-3). Cephalalgia, Volume: 38 issue: 1, page(s): 1-211.
2. Young, William B., MD; Silberstein, Stephen D., MD. “Migraine and Other Headaches.” AAN Press. St. Paul. 2004.
3. Calhoun, Anne H., MD; Ford, Sutapa, PhD; Millen, Cori, DO; Finkel, Alan G., MD; Truong, Young, PhD; Nie, Yonghong, MS. “The Prevalence of Neck Pain in Migraine.” Headache. Published Online: Jan. 20, 2010.