Complex Migraines: What Are They, Symptoms & Treatment

By Jennifer Nadel, MD
Medically reviewed checkmarkMedically reviewed
April 27, 2022

The throbbing, severe pain of migraine attacks—as well as nausea and increased sensitivity to light and sound—can severely limit the ability to function.

But not all migraines are the same.

Some people suffer from complex migraines, which do not always present like typical migraines—and may have more serious symptoms.

Complex migraines are also referred to as hemiplegic migraines, atypical migraine, or migraine with aura.

In this article, I’ll explain what is different between migraine and complex migraine, as well as symptoms, treatment, prevention, and when you should see a doctor.

What is a Complex Migraine?

Complex migraine is not a medical term, but refers to migraines that do not present with the typical four phases of migraine.

Complex migraine may be used to describe hemiplegic migraine, atypical migraine, or migraine with aura.

Complex migraine is less common and presents with symptoms that may overlap with stroke.

Hemiplegic migraines include symptoms that appear to be signs of stroke.

These can include weakness or paralysis on one side of the body and other motor problems, like balance issues and trouble speaking.

Around 18% of patients who present with stroke symptoms end up having hemiplegic migraine.

Hemiplegic migraines also do not follow a typical pattern of migraine phases.

Aura, a phase of migraine that includes neurological disturbances like vision changes, usually occurs for a short period before the attack phase of migraine.

In people with hemiplegic migraine, aura may appear earlier and last longer.

If you experience these symptoms for the first time, seek immediate emergency medical care.

There is no easy way to distinguish between stroke and hemiplegic migraine at home unless you have already been diagnosed with hemiplegic migraine.

If you experience signs of stroke, including weakness on one side of your body, go to the ER or call 9-1-1.

Hemiplegic migraines may happen frequently, or a person may only have one hemiplegic migraine in their lifetime.

Other types of complex migraine can include:

  • Ophthalmoplegic migraine: This type of migraine causes pain behind and around the eyes, as well as vision changes. These symptoms may last for days or weeks.
  • Silent migraine: This type of migraine causes aura, like light sensitivity or neurological symptoms, without head pain.
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What Causes Complex Migraines?

The causes of migraine of any type are not fully understood, but genetics and environmental factors are believed to play a role.

The things that trigger a migraine can vary from one person to another.

Common migraine triggers include:

  • Certain foods (red wine, MSG, chocolate, dairy, alcohol, etc.)
  • Sensory stimulation (loud music, bright lights, strong smells)
  • Stress or anxiety
  • PMS or menstrual changes
  • Weather changes
  • Too much or too little sleep
  • Caffeine (sudden changes to normal intake)

Common risk factors

Your risk for complex migraine or other types of migraine may be higher if you have certain genes or a family history of migraine.

People who are born female may have higher rates of hemiplegic migraine.

Hemiplegic migraines may be associated with variations in three specific genes, though it is unlikely that your doctor will run a genetic test since gene-specific treatments are not yet available.

If you have a family history of hemiplegic migraine, there is a 50% chance that you will get the genetic tendency from a parent.

You don’t need to have a family history of hemiplegic migraine to experience one, though.

Symptoms

Complex migraine symptoms vary.

But hemiplegic migraines tend to only have two distinct phases, versus the normal four phases of migraine.

  • Phase 1: Aura is usually the first sign of hemiplegic migraine. It may present as muscle or motor problems, such as weakness on one side of the body, numbness or tingling, and even feelings of paralysis. It may also include vision changes, like blind spots or double vision, as well as sensitivity to light or sound. Aura may also cause cognitive symptoms such as problems speaking, confusion, and poor concentration. Aura symptoms tend to happen within an hour of migraine onset, but may last for up to a week after the migraine has ended.
  • Phase 2: A migraine attack, or headache, is the second phase, which typically occurs within minutes or an hour after aura begins. It can feel like throbbing, pulsating, intense head pain, usually only on one side. It can also cause nausea, vomiting, light and sound sensitivity, and dizziness. Migraine attacks may last from a few hours to 3 days.

Treatment

Treatment for complex migraine depends on severity, frequency, and specific symptoms.

If you experience hemiplegic migraine symptoms but have not been diagnosed, do not self-treat, as symptoms of a hemiplegic migraine are similar to those of a stroke.

Go directly to an emergency department.

If you know that you have hemoplegic migraines and are certain you are having one, treatment options may include:

Prevention

The best way to address hemiplegic migraines is to understand what may trigger them.

By avoiding known causes, you can avoid concerning symptoms and the pain associated with complex migraines.

If you know that sensory stimulation triggers migraine for you, avoid strong scents, loud noises, and bright lights.

For some people, they may be only very specific triggers in these categories, like secondhand smoke exposure, or flashing lights at a concert.

Certain foods may trigger migraines.

These typically include red wine, dairy products, chocolate, MSG, and other preservatives or artificial flavors.

It is not always possible to avoid stress, but having healthy ways to manage stressful situations may help prevent stress from triggering migraines.

This can include meditation, deep breathing, or working with a therapist.

In some cases, a healthcare provider may prescribe medication that can prevent migraine onset.

These may include:

  • Calcium channel blockers
  • Beta-blockers
  • Anti-seizure medications
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When to See a Doctor

If you notice weakness on one side of your body, seek emergency medical care at an emergency department right away.

Even if you have been diagnosed with hemiplegic migraine, it is still possible to have a stroke.

Until you know what is causing your symptoms, do not self-treat at home.

Outside of an emergency, see a doctor if you have frequent migraines or have symptoms that make it hard to function.

Your doctor can diagnose the cause of your symptoms, prescribe medication for prevention or treatment, and refer you to a neurologist if you require additional testing.

How K Health Can Help

Did you know you can get affordable primary care with the K Health app?

Download K to check your symptoms, explore conditions and treatments, and if needed text with a doctor in minutes. K Health’s AI-powered app is HIPAA compliant and based on 20 years of clinical data.

Frequently Asked Questions

How long can a complex migraine last?
Complex migraines may last longer than typical migraines. The actual migraine phase will typically last a few hours to 3 days, but aura symptoms associated with complex migraine can last for up to a week.
Can a complex migraine lead to a stroke?
Yes. It is possible to have a complex migraine and a stroke or transient ischemic attack at the same time. Both migraine and stroke involve changes to brain blood vessels. People who are prone to migraines may have a higher risk for stroke. When a migraine with aura and a stroke happen at the same time, it is called a migrainous stroke or migrainous infarction.
What is considered a complicated migraine?
A complicated migraine is one that either presents without the typical four phases of migraine, or has a longer-lasting aura. Complex migraines may also include more rare symptoms, such as weakness on one side of the body. This type of migraine is known as a familial hemiplegic migraine.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Jennifer Nadel, MD

Dr. Jennifer Nadel is a board certified emergency medicine physician and received her medical degree from the George Washington University School of Medicine. She has worked in varied practice environments, including academic urban level-one trauma centers, community hospital emergency departments, skilled nursing facilities, telemedicine, EMS medical control, and flight medicine.

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