7 Symptoms of a Complex Migraine You Should Know
Slurred speech, balance problems, brain fog—these are just some of the complex migraine symptoms that can mimic stroke.
A debilitating headache
A migraine isn’t just a headache. It’s a neurological condition that can come with unusual symptoms, like vision changes, nausea, and an aversion to smells.
A migraine isn’t just painful. It arrives with an often throbbing ache, the sort that makes you wonder whether someone’s trying to drill through your skull.
Suffice to say, migraines are no fun.
“Migraine is a disorder of the brain,” says Stephen D. Silberstein, MD, professor of neurology at Thomas Jefferson University and director of the Jefferson Headache Center in Philadelphia.
It is categorized by moderate to severe throbbing pain that’s often one-sided and accompanied by nausea and sensory changes, including sensitivity to light, smell, and sound.
Not only can a migraine disrupt your ability to work, but it cause a cascade of side effects to your mental and physical well-being.
What is a complex migraine?
A complex migraine isn’t a specific type of migraine, and it’s not an official diagnosis.
“It’s an older term that refers to migraines that present with stroke-like symptoms,” says Lauren R. Natbony, MD, assistant professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City.
You might have slurred speech, numbness or tingling on one side of the body, balance problems, brain fog, or double vision.
Stroke-like symptoms can be a part of a migraine aura, one of the phases of a migraine that can either occur before or during the head pain portion. Sometimes, though, you might not feel any head pain at all.
If these symptoms are part of your migraine, you are not having a stroke. However, since strokes are a medical emergency, you should seek help immediately if you think you might be having one.
Within the umbrella of “complex migraine” are several different types of migraine, says Dr. Natbony.
These include vestibular migraine, hemiplegic migraine, and migraine with brainstem aura.
JGI/Jamie Grill/Getty Images
Symptoms of complex migraine
You can imagine how alarming it is to have a migraine that could be mistaken for a stroke. The first time it happens, you might actually assume you’re having a stroke and get it checked out right away. (As you should.)
But there are symptoms you can watch for to help you spot this type of migraine.
Dizziness and vertigo
If you feel like you or the room is spinning—but you’re standing still—you may have a vestibular migraine, says Dr. Silberstein.
Nausea and vomiting are common. You may not be moving, but your brain sure thinks you’re taking back-to-back trips on the Tilt-a-Whirl.
Many people who have vestibular migraines don’t experience head pain with them, according to the Vestibular Disorders Association.
(Here are the causes of vertigo.)
Weakness on one side of the body
This is indicative of a hemiplegic migraine, a very rare type of migraine.
“One side of your body may not work as well as the other side of your body,” during an attack, says Dr. Natbony.
She notes that these symptoms can last 72 hours and, in some cases, persist for weeks.
Poor muscle coordination
Called ataxia, this can occur in both a hemiplegic migraine or a migraine with brainstem aura.
Numbness and tingling
In a migraine with brainstem aura, you may experience numbness or tingling—a pins-and-needles sensation—that travels up your arm and to your face.
Symptoms that occur with this type of migraine typically last up to 60 minutes each, says the American Migraine Foundation (AMF).
Issues speaking, understanding other people when they speak, and slurring may be other signs of a migraine with brainstem aura.
Impaired consciousness, from confusion to coma, can also occur in a hemiplegic migraine, notes the AMF.
Sensitivity to light and sound
Complex migraines often occur with only an aura, no pain involved. So it can sometimes be hard to pinpoint whether you’re having a migraine.
Along with numbness and weakness, a sensitivity to light and sound can indicate that you’re having a migraine.
You might also experience other vision-related changes, such as double vision.
(Here’s what you need to know about ocular migraine.)
When to seek help
Not only will you want to seek help for relief from complex migraines, but you may need to seek out emergency care if you’re not sure whether your migraine is actually a more-serious condition.
When you have stroke-like symptoms
If it is your first time experiencing these symptoms, especially if you have weakness on one side or double vision or impaired sight, don’t assume you’re having a migraine.
“If you have new headache symptoms or ones that are getting progressively worse, you should seek medical attention,” says Dr. Silberstein.
What you don’t want to do is miss a stroke, as recovery from a stroke relies on prompt treatment.
When you get a sudden, severe headache
Another warning sign is experiencing what’s called a “thunderclap headache,” an extremely severe sudden-onset headache, Dr. Silberstein says.
A thunderclap headache can result from life-threatening medical conditions, such as a brain aneurysm.
If you experience one of these, call 911.
In the future
After your doctor has told you that these symptoms are part of the aura that accompanies your migraine, you do not have to panic during future migraine attacks—as long as the symptoms are the same as what you had before.
In other words, you should recognize that what you’re experiencing is a migraine because the same symptoms occur every time you have a migraine. (Remember, if things change, give the doctor a call.)
Use the treatment that your doctor has recommended. If your migraines worsen, become more frequent, or treatment is inadequate, talk to your doctor about making any changes to your plan.
“Aura is a complex topic, and it can be difficult to understand and describe,” says Dr. Natbony.
She recommends drawing out a picture of your aura symptoms. This can include where you feel numbness and tingling and if it “moves” throughout your body.
You might want to write down how long an attack lasts. Or use a migraine-tracking app like Migraine Buddy, which allows you to track specific aura symptoms. All of this can help doctors determine if you are having a migraine or stroke, Dr. Natbony says.
(These are the signs of a silent migraine.)
Treatment for a complex migraine
The best therapy for a complex migraine aims to both treat and prevent the attack.
Treatment depends on the specific type of migraine and also takes into account the aura symptoms that go along with your migraine.
First, your doctor should rule out other medical causes to be sure that your symptoms are migraine related.
To treat, you might use over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
Or you might try a migraine medication like Excedrin, which contains acetaminophen, aspirin, and caffeine.
Triptans (selective serotonin receptor agonists) are a class of prescription drugs that target serotonin receptors to contract arteries in the brain and block pain signals.
They’re taken during the aura—when you feel the dizziness, brain fog, or other symptoms begin to set in.
They’re not the only way to treat a migraine once an attack is in progress. Depending on your migraine type and symptoms, your doctor may prescribe other medications that target specific symptoms.
If you get migraine attacks with dizziness, you might also take a medication that relieves dizziness, says Dr. Silberstein.
If your migraines come with weakness on one side of the body, your physician may consider putting you on a preventive migraine medication, such as a calcium channel blocker, he adds.
If you have hemiplegic migraines, you might take an NSAID or antiemetic, the latter of which can ease nausea and vomiting. This type of migraine isn’t treated with triptans or ergotamines, another popular type of migraine drug.
Migraine prevention tips
As with any migraine, there are two approaches to prevention. You might alter your lifestyle, take a preventive medication, or both.
One is to avoid migraine triggers that set off an attack. Stress and anxiety, allergies, too much caffeine, certain foods, skipping meals, and an irregular sleep schedule can all trigger a migraine attack.
Keeping a regular schedule is key. Be consistent with when you eat, sleep, and drink coffee.
Also, pay attention to the warning signs a migraine is coming, so you can take the steps to stop it.
Preventive medication is different from medications that you might take to relieve symptoms of a migraine.
Instead, preventives are taken daily with the goal of reducing the number of attacks you have per month, plus each attack’s intensity and duration.
Not all preventives will be appropriate for you.
The best preventive will depend on the type of migraine you have (some medications are not suitable for certain types of migraines). According to the AMF, common options include:
- Blood pressure medications, such as beta-blockers and calcium channel blockers
- Antidepressants, such as tricyclic antidepressants and selective serotonin reuptake inhibitors
- Serotonin antagonists
If you have more than 10 migraine days per month, Dr. Natbony suggests going on a preventive medication.
Migraines are considered chronic when you have 15 headache days per month or more. Using a preventive medication can help, well, prevent your disease from entering into chronic migraine territory.
Next, learn about the foods that can trigger a migraine.
- Stephen D. Silberstein, MD, professor of neurology at Thomas Jefferson University and director of the Jefferson Headache Center in Philadelphia
- Lauren R. Natbony, MD, assistant professor of neurology at the Icahn School of Medicine at Mount Sinai in New York City
- National Center for Biotechnology Information: "Migraine with Aura"
- American Migraine Foundation: "Hemiplegic Migraine"
- American Migraine Foundation: "What to Know About Vestibular Migraine"
- Vestibular Disorders Association: "Vestibular Migraine"
- American Migraine Foundation: "Preventive Treatments"
- American Migraine Foundation: "Migraine with Brainstem Aura (Basilar Type Migraine)"
- National Center for Biotechnology Information: "Triptans"