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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Neurology · Migraine

Defining Your Diagnosis: Subtypes and Classifications

At a Glance

Doctors classify migraines by frequency (episodic vs. chronic) and symptoms (with or without aura). Knowing your specific subtype, such as vestibular or hemiplegic migraine, helps your neurologist prescribe the most effective targeted treatments for your condition.

Migraine is a spectrum, and your specific experience may fit into several different categories based on how often your attacks occur and the types of symptoms you feel. Doctors use a standardized “language” called the ICHD-3 to classify these subtypes, which helps them tailor your treatment plan [1][2].

Frequency: Episodic vs. Chronic Migraine

The most basic way doctors categorize migraine is by how many days of the month you are affected.

  • Episodic Migraine: This is the classification for most people. It means you have fewer than 15 headache days per month [3].
  • Chronic Migraine: This is defined by a specific 15/8 threshold. To meet this diagnosis, you must have a headache on at least 15 days per month for at least three months, and on at least 8 of those days, the pain must be a migraine [2].
  • Reversion: The good news is that these categories aren’t always permanent. Newer treatments, such as CGRP-targeted monoclonal antibodies, have been shown to help patients “revert” from chronic migraine back to the episodic stage [4][5].

Presentation: With or Without Aura

Another major division is based on the presence of an aura—temporary neurological changes that usually occur just before the pain begins [6].

  • Migraine Without Aura: This is the most common form, where the headache occurs without warning signs [1].
  • Migraine With Aura: This involves reversible symptoms like seeing flashing lights, feeling “pins and needles,” or having trouble speaking [6][7]. These symptoms usually last between 5 and 60 minutes [8].

Specialized Subtypes

Some forms of migraine involve symptoms that can be particularly frightening or difficult to diagnose.

Vestibular Migraine

This subtype is characterized by recurrent episodes of vertigo (a spinning or swaying sensation) [9].

  • The Confusion with Ménière’s: Vestibular migraine is often misdiagnosed as Ménière’s disease because both involve dizziness and can cause ear pressure [10][11].
  • Differentiating: While Ménière’s disease is typically linked to progressive hearing loss and specific abnormalities on balance tests, vestibular migraine is more likely to include standard migraine features like light sensitivity [11][12].

Hemiplegic Migraine

This is a rare and severe form of migraine with aura where the “aura” includes hemiplegia—temporary weakness or paralysis on one side of the body [13][14].

  • Stroke Mimic Warning: Any new onset of one-sided weakness requires immediate emergency medical evaluation to rule out a stroke. Do not assume it is a hemiplegic migraine until emergency doctors confirm it.
  • Genetic Factors: Hemiplegic migraine often runs in families and is linked to specific genetic mutations, such as CACNA1A, ATP1A2, SCN1A, or PRRT2 [15][16].
  • Testing: Doctors may recommend genetic testing if you have one-sided weakness, especially if a parent or sibling also experiences it [15][17]. Note that sporadic (non-inherited) forms also exist and can be just as severe as familial cases [18].

Knowing your subtype is more than just a label—it is a roadmap for your care team to choose the most effective medications for your specific brain [2].

Common questions in this guide

What is the difference between episodic and chronic migraine?
Episodic migraine involves having fewer than 15 headache days per month. Chronic migraine is diagnosed when you experience 15 or more headache days a month for at least three months, with at least 8 of those days being migraine attacks.
Can chronic migraine go back to being episodic?
Yes, chronic migraine is not necessarily a permanent condition. With modern preventive treatments, such as CGRP-targeted therapies, many patients can successfully revert from chronic migraine back to episodic migraine.
What are the symptoms of vestibular migraine?
Vestibular migraine causes recurrent episodes of vertigo, dizziness, or a swaying sensation, often accompanied by classic migraine features like light sensitivity. Because it can cause ear pressure, it is sometimes misdiagnosed as an inner ear disorder called Ménière's disease.
What should I do if I experience one-sided weakness during a migraine?
Any new onset of one-sided weakness or temporary paralysis requires immediate emergency medical evaluation to rule out a stroke. Once a stroke is ruled out, a doctor can determine if you are experiencing a rare condition known as hemiplegic migraine.
When should I get genetic testing for my migraines?
If you have a family history of temporary paralysis or severe weakness during headache attacks, your doctor may recommend genetic testing. Mutations in specific genes, such as CACNA1A or PRRT2, are strongly linked to familial hemiplegic migraine.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Do I meet the specific 15/8 criteria for chronic migraine, or is my case considered episodic?
  2. 2.If my aura symptoms like dizziness or weakness last longer than an hour, does that change my diagnosis?
  3. 3.How do you differentiate my vertigo from Ménière’s disease, especially if I have ear fullness but no hearing loss?
  4. 4.Given my symptoms of one-sided weakness, should I be referred for genetic testing for CACNA1A or PRRT2 mutations?
  5. 5.Could my preventive treatment help me 'revert' from chronic migraine back to episodic migraine?

Questions For You

Tap a prompt to share your answer — we'll use it plus this page's context to start a tailored conversation.

References

References (18)
  1. 1

    How Well Does the ICHD 3 (Beta) Help in Real-Life Migraine Diagnosis and Management?

    Ashina S, Olesen J, Lipton RB

    Current pain and headache reports 2016; (20(12)):66 doi:10.1007/s11916-016-0599-z.

    PMID: 27873122
  2. 2

    The burden of high-frequency episodic migraine and chronic migraine in the population-based PopHEAD study.

    Engstrand H, Argren MB, Zwart JA, et al.

    Cephalalgia : an international journal of headache 2025; (45(12)):3331024251406103 doi:10.1177/03331024251406103.

    PMID: 41406073
  3. 3

    Estimating quality of life in a headache referral population based on Migraine disability assessment scale and headache impact test.

    Togha M, Seyed-Ahadi M, Jafari E, et al.

    Current journal of neurology 2020; (19(2)):76-84 doi:10.18502/cjn.v19i2.4944.

    PMID: 38011406
  4. 4

    Conversion from chronic to episodic migraine in patients treated with galcanezumab in real life in Italy: the 12-month observational, longitudinal, cohort multicenter GARLIT experience.

    Altamura C, Brunelli N, Marcosano M, et al.

    Journal of neurology 2022; (269(11)):5848-5857 doi:10.1007/s00415-022-11226-4.

    PMID: 35763113
  5. 5

    Real-life assessment of erenumab in refractory chronic migraine with medication overuse headache.

    Pensato U, Baraldi C, Favoni V, et al.

    Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology 2022; (43(2)):1273-1280 doi:10.1007/s10072-021-05426-5.

    PMID: 34224026
  6. 6

    Recent Insights in Migraine With Aura: A Narrative Review of Advanced Neuroimaging.

    Russo A, Silvestro M, Tessitore A, Tedeschi G

    Headache 2019; (59(4)):637-649 doi:10.1111/head.13512.

    PMID: 30953581
  7. 7

    Can you have a migraine aura without knowing it?

    Hadjikhani N, Vincent M

    Current opinion in neurology 2021; (34(3)):350-355 doi:10.1097/WCO.0000000000000924.

    PMID: 33661163
  8. 8

    Migraine aura symptoms: Duration, succession and temporal relationship to headache.

    Viana M, Linde M, Sances G, et al.

    Cephalalgia : an international journal of headache 2016; (36(5)):413-21 doi:10.1177/0333102415593089.

    PMID: 26156076
  9. 9

    Emerging evidence for noninvasive vagus nerve stimulation for the treatment of vestibular migraine.

    Beh SC

    Expert review of neurotherapeutics 2020; (20(10)):991-993 doi:10.1080/14737175.2020.1806060.

    PMID: 32748659
  10. 10

    [Clinical characteristics analysis of patients with Meniere's disease and vestibular migraine].

    Chen Y, Sun H, Zhang Q, et al.

    Lin chuang er bi yan hou tou jing wai ke za zhi = Journal of clinical otorhinolaryngology head and neck surgery 2020; (34(9)):820-823 doi:10.13201/j.issn.2096-7993.2020.09.012.

    PMID: 33040507
  11. 11

    Vestibular migraine.

    Silva VPR, Castro LHM, Calderaro M

    Arquivos de neuro-psiquiatria 2022; (80(5 Suppl 1)):232-237 doi:10.1590/0004-282X-ANP-2022-S111.

    PMID: 35976301
  12. 12

    Is there a difference in the results of the video head impulse test in patients with a nosological diagnosis of Ménière's Disease and Vestibular Migraine?

    Aguiar MCF, Nascimento GFFD, Costa APM, et al.

    CoDAS 2025; (37(1)):e20230359 doi:10.1590/2317-1782/e20230359pt.

    PMID: 39841738
  13. 13

    [Hemiplegic migraine: from historical perspectives to current management].

    Shibata M, Saigoh K, Danno D, et al.

    Rinsho shinkeigaku = Clinical neurology 2026; (66(6)):375-383 doi:10.5692/clinicalneurol.cn-002244.

    PMID: 42178246
  14. 14

    Reduced Frequency of Prolonged Sporadic Hemiplegic Migraine Attacks Following Fremanezumab Treatment-A Case Report.

    Hotz JF, Kaindl L, Krebs S, et al.

    European journal of neurology 2026; (33(2)):e70514 doi:10.1111/ene.70514.

    PMID: 41589756
  15. 15

    A Case Report of Hemiplegic Migraine with Mutation in the ATP1A2 Gene.

    Guan DM, Shan YZ, Zhao HT, et al.

    Pharmacogenomics and personalized medicine 2024; (17()):437-442 doi:10.2147/PGPM.S473335.

    PMID: 39319208
  16. 16

    Progressive Ataxia with Hemiplegic Migraines: a Phenotype of CACNA1A Missense Mutations, Not CAG Repeat Expansions.

    Duque KR, Marsili L, Sturchio A, et al.

    Cerebellum (London, England) 2021; (20(1)):134-139 doi:10.1007/s12311-020-01185-9.

    PMID: 32888184
  17. 17

    Next-generation sequencing identified a novel CACNA1A I1379F variant in a familial hemiplegic migraine type 1 pedigree: A case report.

    Luan H, Zhang L, Zhang S, Zhang M

    Medicine 2021; (100(51)):e28141 doi:10.1097/MD.0000000000028141.

    PMID: 34941060
  18. 18

    Hemiplegic migraine.

    de Boer I, Hansen JM, Terwindt GM

    Handbook of clinical neurology 2024; (199()):353-365 doi:10.1016/B978-0-12-823357-3.00015-X.

    PMID: 38307656

This page explains migraine subtypes and classifications for educational purposes only. Always consult a neurologist for an accurate diagnosis, and seek emergency care for any new onset of one-sided weakness or stroke-like symptoms.

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