Thread by @beth_morton

Week 2 #MigraineChatAMA - #migraine types: You had some tough Qs & I don’t have all the answers. Just because I didn’t find them in my search, doesn’t mean they don’t exist. If you have reliable sources of information, please share. Errors are mine. For more info, click links. /1

Types: 2 main types are migraine without aura (MwoA) & migraine with aura (MwA). Under MwA are migraine w/: typical aura*, brainstem aura, hemiplegic & retinal migraine. *Migraine w/typical aura also incls migraine without headache. migraineagain.com/10-types-of-mi…
#MigraineChatAMA /2

Types, cont: menstrual migraine (MM) is a subtype under either MwoA or MwA. If attacks happen only during menses = pure MM. Migraine attacks during menses and other times = mensturally-related migraine.

MM can be tougher to treat.
healthline.com/health/migrain…
#MigraineChatAMA /3

Types, cont: the ICHD-3 also classifies additional migraine types as syndromes associated with migraine, like vestibular migraine and abdominal migraine. ichd-3.org/1-migraine/
#MigraineChatAMA /4

Migraine can be classified by frequency.
-Episodic migraine (EM): < 15 days a month
-Chronic migraine (CM): > 15 days a month with 8+ days being migraine for 3+ mos.
But there is recent debate about this split. …adachejournal.onlinelibrary.wiley.com/doi/10.1111/he…
#MigraineChatAMA /5

Where it gets a bit muddied:
- Status migraine: an attack lasting > 72 hrs, possible either w/ EM or CM.
- Refractory migraine: resistant to treatment (# of txs seems debatable).
- Intractable migraine seems to have been used synonymously with both of these.
#MigraineChatAMA /6

Articles on status vs. refractory vs. intractable migraine:
1: …alofheadacheandpain.biomedcentral.com/articles/10.11…
2: proquest.com/openview/f9882…
#MigraineChatAMA /7

Sinus migraine is a newer idea stemming from the involvement of sinus pain or symptoms in migraine and the fact that most people who think they have sinus “headache” actually fit migraine criteria. #MigraineChatAMA /8

There are dozens of other informal migraine labels you might hear that are not actual diagnoses or old names for diagnoses above.

E.g., "Cluster migraine" is not a diagnosis (cluster headache is a different headache disorder).
#MigraineChatAMA /9

Your Questions:

Is there a limit to the # of migraine diagnoses (dx) someone can have?

Not that I could find. Some types probably supersede others, though (aura vs. no aura). #MigraineChatAMA /10

That said, it's important to get an accurate dx. You might end up with >1 dx if symptoms change or you see diff docs: e.g.,

MwA might actually be vestibular migraine if certain symptoms are dismissed/not included in initial diagnosis. #MigraineChatAMA /11

Diff btw migraine & cervicogenic headache (CGH), & how to treat the latter.

CGH is a secondary HA type; caused by illness or something structural. #MigraineChatAMA /12

CGH, cont: CGH is a disorder of “the cervical spine & its component bony, disc &/or soft tissue elements, usually but not invariably accompanied by neck pain.” #MigraineChatAMA /13

CGH, cont: Migraine is a primary headache; a condition of its own, not caused by something else.

Migraine & CGH sxs can overlap but CGH can be dx'edthrough imaging of the cervical spine.

With migraine, imaging is typically only *rules out* other issues. #MigraineChatAMA /14

CGH, cont: Treatment for CGH will focus on any issues identified in the spine, so things like nerve/other blocks, physical therapy, etc. migraineagain.com/understanding-…
#MigraineChatAMA /15

CGH, cont: Caveat… migraine treatments might help in some CGH headache cases. See @CSWhiteMD’s explanation on why this might be:

https://twitter.com/cswhitemd/status/1532546319423782918?s=21&t=S-HhKzMw3ZBnd6NnUHIM-Q

#MigraineChatAMA /16

Extended prodrome? Longer than attack phase?

Yes! Prodrome can last a few hours to a few days. Migraine (untreated) *typically lasts 4-72 hrs. You can experience prodrome for a few days but an attack for less (esp if your acute tx aborts the attack phase). #MigraineChatAMA /17

Related, some people can have intractable aura where aura symptoms are constant/near constant. #MigraineChatAMA /18

Are there migraine subtypes that have stronger digestive components?
Aside from abdominal migraine, I didn’t find anything that said one type was more prone to GI issues. However, GI symptoms (& comorbidities) are common w/migraine. healthline.com/health/gastric… #MigraineChatAMA /19

See the August special #MigraineChat topic for more on managing migraine and GI conditions/symptoms. Transcript here (bottom of page): bit.ly/MigraineChat

For ppl with >1 headache disorder, does knowing this help narrow treatments?

I don’t have a good answer. Only that for migraine & cluster headache, some treatments are approved for both (e.g., Emgality, gammaCore). #MigraineChatAMA /20

Cont: Some headache diagnoses might mean some treatments are contraindicated or make them a poor fit for other diagnoses. This is a conversation best had with your migraine specialist. #MigraineChatAMA /21

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