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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

Summary:

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 (see Is It Time for a New Migraine Doctor?), get an accurate diagnosis, and work with your doctor toward the best Migraine management possible.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Headache Classification Subcommittee of the International Headache Society. "The International Classification of Headache Disorders 2nd Edition." Cephalalgia 2004;24:8-160. -- Interviews: Teri Robert with Serene Branson. June 7, 2011; June 25, 2011.

Comments

  • Eric Knox
    7 years ago

    Thanks for this great post! Much appreciated!

  • Janene Zielinski
    7 years ago

    Sometimes it’s hard for me to tell when I have a basilar migraine, or if it’s just a migraine with aura. I am now skittish to just “pop a Zomig”. Basilar migraine is new for me in the last five years after having migraines my whole life. Symptoms can be as confusing as terminology.

  • Teri-Robert author
    7 years ago

    w7afb,
    It would seem your doctor is using “complex” to describe your situation with having more than one form of Migraine – using the word descriptively, not as a diagnosis of a type of Migraine. I hope he’s told you what types of Migraines you have. We do need to know that. Weakness on your left side could very well indicate that the Migraines that cause that are hemiplegic Migraines.

  • w7afb
    7 years ago

    My doctor explained that I have Complex Migraines because I have symptoms of several types. I do have auras before an attack centered behind left eye. I also have left hand tremor and weakness on left side. My speech is reduced to labored one word at a time. Headache pain is 10+. These attacks occur 3 or more times a day. They last from 20 min. to 2 hours.

  • Paula Diaz
    7 years ago

    what if you get 1.1 or 1.2.3 or 1.2.4 or 1.2.6 or even 1.4 for several weeks then for several days/weeks/months get nothing at all – is that complicated or just plain weird.

  • Teri Robert
    7 years ago

    It can be described as complicated, Paula, but your diagnosis would still be Migraine with aura, basilar-type Migraine, and so on. See what I mean? You can definitely have more than one type of Migraine, but to have both familial hemiplegic Migraine and basilar-type Migraine would be very rare. If you’re in that situation, I hope you’re seeing a good Migraine specialist.

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