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If your migraine attack causes symptoms other than one-sided head pain and other standard signs, you may have atypical or complicated migraine. This means you’re living with the neurological condition known as migraine, but your symptoms are different from what most people usually experience.
“Last month I had a severe atypical migraine attack,” one MyMigraineTeam member said. “The doctor thought I had a stroke or brain bleed, but MRI/CT scans were negative. It lasted seven days.”
Another member said, “I’ve had dizziness every day for over five years and doctors all chalk it up to atypical migraine.”
This article explains what atypical migraine is, how the symptoms appear, and how neurologists pinpoint a diagnosis.
Atypical or complicated migraine are terms that describe migraine episodes with unusual neurological symptoms. These can include:
Migraine attacks look different for everyone. Symptoms that may be considered atypical or complicated for you could be normal for someone else.
Atypical and complicated migraine aren’t official medical diagnoses. These terms don’t appear in the International Classification of Headache Disorders (ICHD-3) guidelines. But they may still be used to describe migraine attacks with features that are different from normal migraine patterns.
Typical migraine attacks include a prodrome phase, aura phase, headache, and postdrome phase. These may not happen in complicated or atypical migraine attacks.
Doctors often use more precise terms than atypical and complicated to explain unique neurological symptoms involved in migraine attacks. Several officially recognized migraine subtypes feature unusual or complex symptoms.
Hemiplegic migraine is a rare type of migraine, affecting roughly 1 in 10,000 people. It can cause one side of the body (face, arm, and leg) to feel weak. This happens alongside migraine symptoms such as changes in vision (flashing lights, zigzags, blind spots) or speech, or sensory changes. Hemiplegic migraines can also cause confusion, fatigue, and tingling or numbness in your arms, legs, or face. These symptoms typically resolve within a few hours, but some may last up to a few weeks.
Hemiplegic migraine can be genetic. This is also referred to as familial hemiplegic migraine. This happens when a certain gene is passed down in your family, making you more likely to develop the condition. If it’s not caused by genetics, then it’s called sporadic hemiplegic migraine.
People often undergo extensive testing before receiving a hemiplegic migraine diagnosis. This may include an exam, imaging, and genetic evaluation.
Because symptoms of hemiplegic migraine are so similar to those of a stroke, it can be alarming. If you’re having any stroke-like symptoms, such as trouble speaking, changes in your vision, or muscle weakness on one side of your body, call 911 right away.
Migraine with brainstem aura involves symptoms that start in a part of the brain called the brainstem. This was previously known as basilar migraine. Unlike hemiplegic migraine, migraine with brainstem aura doesn’t cause motor or muscle weakness. Attacks last 20 to 60 minutes on average.
A diagnosis of migraine with brainstem aura requires at least two of the following symptoms:
A migraine aura usually happens about 30 minutes to an hour before a migraine attack begins. For most people, aura symptoms involve disturbances that affect your vision, hearing, or speech.
While it’s rare, some people may experience an aura that lasts more than a week, with no evidence of stroke on brain imaging. If you have symptoms of an aura for at least a week without signs of a stroke, it’s considered migraine with persistent aura.
Talk with your doctor if you notice a persistent aura. Together, you can make sure your symptoms aren’t caused by other, more serious conditions.
No single test can confirm a migraine diagnosis. For that reason, healthcare providers usually use a step-by-step approach to evaluate your neurological symptoms.
Most of the time, doctors will begin by asking you for a detailed medical history. They may ask questions about the types of symptoms you experience, how severe they are, and how long they usually last. You may be asked to describe the location of your headaches and what they feel like. You’ll be asked to share any family medical history, too.
You may be asked to keep a headache diary, including their dates, length, and other factors that might trigger your headaches.
Your healthcare provider will also conduct neurological exams. Based on your symptoms and medical or family history, your doctor will evaluate your reflexes, coordination, strength, balance, and language skills. This may help them determine whether your symptoms are caused by migraine or another medical concern.
Sometimes, blood tests or brain imaging, like an MRI or CT scan, are used to rule out other causes. If your doctor suspects hemiplegic migraine, they may also conduct a spinal tap (lumbar puncture) or electroencephalogram (EEG). Because hemiplegic migraine can be passed down by family members, you may also need to undergo genetic testing.
Some atypical migraine symptoms can look very similar to medical emergencies, which can be confusing and even scary at times. For instance, sudden weakness on one side of the body, along with numbness, tingling, and trouble speaking, can also signal a stroke.
The causes of these symptoms can be hard to tell apart. But there are a few key differences between atypical migraine attacks and more serious causes. In general, symptoms of migraine usually happen gradually over time. Symptoms are also considered to be positive, meaning they add sensations, like tingling in the body or flashes in vision.
On the other hand, symptoms of other medical concerns, like a stroke, are more sudden. They tend to include negative symptoms that cause you to lose sensations in the body. This can include losing feeling in a body part or not being able to see out of one eye.
No matter the cause, you should always seek medical care if you notice new symptoms or changes in your body. Contact 911 if you experience any new or worsening:
Diagnosing specific migraine types requires a detailed history, neurological exam, and additional testing to rule out serious conditions such as stroke. Because some migraine symptoms can be very similar to stroke symptoms, it’s important to seek urgent care if new or severe neurological symptoms appear.
If your neurology team describes your migraine symptoms as atypical or complicated, ask detailed questions about your treatment options. Together with your doctor, you can create a migraine treatment plan that helps you reduce your symptoms and improve your quality of life.
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
What’s been the most unusual or unexpected symptom you’ve experienced during a migraine attack? Let others know in the comments below.
Are your headaches a symptom of migraine? Get a quick assessment.
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