Do you suffer from migraines with a severe aura that lasts days or weeks? Do you have other atypical migraine symptoms? If so, you may have a complex migraine.

Complex migraine is a replacement term for complicated migraine. Today many specialists refer to various types of migraines in more specific clinical terms that go under the umbrella of complex migraines, such as:

• Migraine with aura
• Basilar type migraine
• Ophthalmoplegic migraine
• Retinal migraine
• Familial hemiplegic migraine

Complex migraines have more going on and tend to last longer with more symptoms than a typical migraine. This post will get into the symptoms of complex migraines, how they are diagnosed, any risk factors, and treatments and preventions. 

Symptoms

Complex migraines often come with distinct phases. 

In the first phase, you may have an aura episode that can last for minutes or days before the migraine hits. The aura may include or be accompanied by:

• Vision changes, like blind spots, double vision, or zig-zag flashes of light
• Changes in the ability to think clearly
• Difficulty speaking clearly or at all
• Weakness on one side of the body that ranges from mild to severe

The first phase may last around an hour, but you might experience it for up to a week.

The second phase is the migraine. You might suffer more than the typical head pain. You also experience:

• Nausea 
• Light and/or sound sensitivity
• Vomiting 

The head pain can be throbbing and very intense. The migraine may last for several days. The symptoms do eventually go away, unlike those of a stroke, which causes lasting problems.

Diagnosis

With complex migraines, it’s essential to get an accurate diagnosis. The symptoms mimic other serious medical issues that must be ruled out promptly so you receive the correct treatment.

Complex migraines may present as a stroke with vision and speech issues or one-sided bodily weakness. If you observe facial drooping or sudden changes in your consciousness level, seek emergency treatment.

Diagnosing Familial Hemiplegic Migraine

Familial hemiplegic migraine (FHM) has a genetic component that is part of the diagnosis. To determine FHM, the physician looks for the following:

• Aura with fully reversible motor weakness and one or more symptoms of visual, sensory, or dysphasic speech disturbances. 
• Two or more of these symptoms:
  • At least one aura symptom developing gradually over five or more minutes and/or different aura symptoms occurring in succession over five or more minutes.
  • Aura symptoms lasting more than five minutes and less than 24 hours
  • A headache lasting between four and 72 hours with pulsating quality, unilateral location, or moderate to severe pain intensity, along with nausea or vomiting, photophobia, or phonophobia.
• The patient must have at least one first or second-degree relative who has the same type of attacks.

Basilar- type migraines are diagnosed when a patient has at least two attacks with the following symptoms:

• Fully reversible sensory, visual, or speech aura without motor weakness
• Two or more fully reversible symptoms of dysarthria, vertigo, tinnitus, decreased hearing, double vision, ataxia, decreased consciousness, bilateral symptoms, and simultaneous bilateral paresthesia
• An aura lasting more than five minutes and up to 60 minutes, or the aura symptoms develop gradually over five minutes or change over five minutes
• A headache lasting four to 24 72 hours with many of the same symptoms of FHM

In all cases, the symptoms and pain cannot be attributed to another disorder.

Risk Factors

Some people have a genetic predisposition for complex migraines. Researchers have found changes in three genes that may cause someone to develop FHM or migraines with one-sided bodily weakness. 

The genes help with nerve cell function in the brain. Unfortunately, the researchers have not defined how the genes lead to migraine. If you are interested, the identified genes are ATP1A2, CACNA1A, and SCN1A.

Prevention

You may not be able to prevent every migraine, but you can reduce the frequency and severity. Do you have any migraine triggers? Keeping a daily migraine diary can help you and your doctor figure out what might be causing the problem.

Keep notes about: 

• The dates and duration of your migraines
• Any food or drink you had before the migraine
• How much sleep you get each night and notes about your daily routine
• Stress levels

Triggers can include eating certain foods, experiencing physical exertion, exposure to bright light, and feeling stress. Cheese and wine may be a culprit. Or maybe you haven’t been sleeping enough (or too much). 

Other triggers include:

• Hormones 
• Caffeine 
• Alcohol
• Dehydration 
• Overly bright lights
• Medication overuse (rebound headaches)

Your physician might try medication to prevent migraines, such as anti-seizure medications, beta-blockers, and calcium channel blockers.

Treatment

Once the migraine begins, you have options to help you get through it. With a complex migraine, you could have a bit more time to get ready for the head pain. On the other hand, with severe symptoms, you might require a visit with your healthcare professional.

A dark, quiet, cool room can help with light and sound sensitivity. Non-steroidal anti-inflammatories (NSAIDs) can help with the pain. Acetaminophen, ibuprofen, and naproxen are common choices.

If you experience nausea and vomiting, an anti-nausea drug or anti-emetic can calm your stomach. 

If those don’t work, your doctor may prescribe medications. Some physicians begin with triptans or ergots. However, these drugs are vasoconstrictors and aren’t always appropriate when you already have potential vascular (blood flow) issues. If you are experiencing ataxia, hemiplegia, or ophthalmoplegia, triptans may not be the best choice.

Benzodiazepines can help shorten the duration of head pain and other symptoms in some patients. Opioids, on the other hand, aren’t usually helpful. Rebound headaches are an issue with opioids and other medications.

Conclusion

Complex migraines often come with some alarming symptoms, including weakness on one side of the body, vision changes, and difficulty speaking. Many symptoms are the same as those of a stroke. Doctors diagnose a migraine for around two percent of all patients with stroke-like symptoms 

Complex migraines are serious matters, partly because they have the same symptoms as other severe illnesses like stroke. If you think you have complex migraine, it’s important to visit a migraine specialist to receive the correct diagnosis and rule out other problems.