From the Guidelines
A complex migraine, also known as migraine with aura, is a type of migraine headache that includes neurological symptoms beyond the typical pain, and the most recent and highest quality study recommends a comprehensive approach to diagnosis and management, including patient education and a multidisciplinary treatment plan 1.
Definition and Symptoms
A complex migraine is characterized by neurological symptoms such as visual disturbances, sensory changes, speech difficulties, weakness on one side of the body, or confusion, which can mimic a stroke. These aura symptoms typically develop gradually over 5-20 minutes and usually last less than an hour before the headache begins.
Treatment
Treatment includes both acute medications like triptans (sumatriptan, rizatriptan), NSAIDs (ibuprofen, naproxen), or anti-nausea medications (metoclopramide), and preventive options for frequent sufferers such as beta-blockers (propranolol), antiseizure medications (topiramate), or CGRP antagonists (erenumab) 1.
Management
During an attack, patients should rest in a dark, quiet room and apply cold compresses. Complex migraines result from abnormal brain activity causing both neurological symptoms and pain, with the aura believed to be related to a wave of electrical activity spreading across the brain's surface. If experiencing these symptoms for the first time, medical evaluation is important to rule out more serious conditions like stroke.
Key Recommendations
- Patient education and a multidisciplinary treatment plan are essential for effective management of complex migraines 1.
- A comprehensive approach to diagnosis and management should include ruling out secondary causes of headache, making the correct diagnosis, and establishing a comprehensive management plan 1.
- Treatment should be tailored to the individual patient's needs, and may include a combination of acute and preventive medications, as well as non-pharmacological therapies such as relaxation training, biofeedback, or cognitive-behavioral therapy.
From the Research
Definition of Complex Migraine
- A complex migraine is a type of migraine that is characterized by a combination of symptoms, including throbbing headaches, sensory disturbances, nausea, and sensitivity to light and sound 2, 3.
- It is a debilitating neurological disorder that can have a significant impact on a person's quality of life 2, 4.
Symptoms of Complex Migraine
- The symptoms of complex migraine can include:
Pathophysiology of Complex Migraine
- The pathophysiology of complex migraine is complex and not fully understood, but it is thought to involve multiple neuronal systems and the activation of the trigeminovascular pathway 3, 5.
- The disorder is characterized by an abnormal perception of otherwise normal circumstances, such as pain without evidence of primary nociceptive activation, and light and sound sensitivity without change in ambient stimuli 4.
- The brain is altered structurally and functionally in people with complex migraine, with advances in genetics research and clinical trials methodology offering promise for better understanding the underlying pathophysiologic mechanisms 5.