Complex and Complicated Migraine - The Scoop
As if there's not enough confusion about Migraines, the terminology used can create more. We not infrequently see the phrases "complex Migraine" and "complicated Migraine."
In fact, we saw the phrase "complex Migraine" used quite a lot back in February of 2011 when reporter Serene Branson experienced severe aphasia as part of a Migraine while on-air reporting from the Grammy Awards. The headlines and news reports were replete with mentions of her "complex Migraine."
When it comes to formal diagnoses of types of Migraine, however, there is no diagnosis of complex or complicated Migraine under the International Headache Society's International Classification of Headache Disorders, 2nd Edition (ICHD-II), which is the gold standard for diagnosing and classifying Migraine and other headache disorders. In Miss Branson's case, the word "complex" was used by her doctor, Dr. Andrew Charles, in a descriptive manner. Her diagnosis was, in fact, Migraine with aura.
Some doctors who aren't very familiar with Migraine may use "complex" and "complicated" as diagnostic terms. There are reasons this presents problems:
- Since these aren't standard diagnoses under ICHD-II, their use varies and may not mean the same from one doctor to the next.
- A Migraineur who has received one of these diagnoses, then needs to seek care from a different doctor, is at a disadvantage because their diagnosis is not one another doctor will be able to easily recognize.
- Migraineurs who have been given these diagnoses cannot easily find patient education information.
- It is important that a Migraine diagnosis be correct, especially since some medications should not be used with certain types of Migraine. For example: Most doctors do not want to prescribe triptans or ergotamines for patients with basilar-type or hemiplegic Migraine.
For your edification, here's a list of the types of Migraine from the ICHD-II:
1.1 Migraine without aura
1.2 Migraine with aura
1.2.1 Typical aura with migraine headache
1.2.2 Typical aura with non-migraine headache
1.2.3 Typical aura without headache
1.2.4 Familial hemiplegic migraine (FHM)
1.2.5 Sporadic hemiplegic migraine (SHM)
1.2.6 Basilar-type migraine
1.3 Childhood periodic syndromes that are commonly precursors of migraine
1.3.1 Cyclical vomiting
1.3.2 Abdominal migraine
1.3.3 Benign paroxysmal vertigo of childhood
1.4 Retinal migraine
1.5 Complications of migraine
1.5.1 Chronic migraine
1.5.2 Status migrainosus
1.5.3 Persistent aura without infarction
1.5.4 Migrainous infarction
1.5.5 Migraine-triggered seizures
1.6 Probable migraine
1.6.1 Probable migraine without aura
1.6.2 Probable migraine with aura
1.6.5 Probable chronic migraine
If your doctor tells you that you have "complex" or "complicated" Migraine, ask if that's a description or your diagnosis. If the response is that it's your diagnosis, a second opinion to get a more complete and accurate diagnoses is in order. Migraine can be confusing, but we can reduce that confusion by educating ourselves and not hesitating to ask our doctors when we have questions.
What type or types of Migraine we have - and yes, we can have more than one - is so integral to taking care of ourselves that it's something we must know. If your doctor doesn't know enough about Migraine to diagnose, then he or she shouldn't be your choice for treating you for Migraine. Consider a new doctor, get an accurate diagnosis, and work with your doctor toward the best Migraine management possible.
How much has your migraine disease changed or evolved over time?