Key Types of Migraine with Aura and Nutritional Approach to Their Treatment

If you’ve been experiencing frequent migraine attacks, you might be wondering which type of migraine you are experiencing. Some experience severe nausea with vomiting while others find it difficult to speak when having migraine attacks. Most migraine sufferers may experience cognitive symptoms, visual symptoms, depression, and anxiety. Some will even experience all of the symptoms together. That being said, migraine symptoms vary from person to person. 

If you’re trying to research which type of migraine you have, you probably notice that there’s a long list of migraine types. In reality, there are only two main migraine categories—Migraine with Aura and Migraine Without Aura. 

In this article, we will discuss the three main subtypes under Migraine with Aura namely:

• Vestibular Migraine
• Migraine with Brainstem Aura
• Hemiplegic Migraine

Now, let’s discuss these key types of migraine with aura.

Vestibular Migraine

A vestibular migraine causes repeated dizziness or also known as vertigo in people who have a history of migraine. Migraines are mostly characterised by throbbing or pounding headaches, but with vestibular migraine, you won’t always experience headaches during migraine attacks. The word “vestibular” refers to the inner ear, this controls your balance and hearing. People who experience vestibular migraines might feel like objects are moving around them. 

There are different names for this type of migraine with aura. Your healthcare provider might also call it:

• Migraine-associated vertigo
• Migrainous vertigo
• Migraine-related vestibulopathy

Symptoms of Vestibular Migraine

The symptoms for vestibular migraines can include any of the following:

• Dizziness or vertigo that lasts up to several hours or days
• Nausea and vomiting
• Loss of balance
• Extreme motion sensitivity 
• Feeling disoriented or confused
• Feeling unsteady
• Sensitivity to sound
• Sensitivity to light, noise, and smell
• Memory issues 
• Difficulty concentrating
• Visual auras or flashing lights
• Hearing changes or ringing/buzzing sounds in your ears

How is Vestibular Migraine Diagnosed?

Majority of people who have vestibular migraines do not have headaches and vestibular symptoms at the same time. Since there’s no imaging or blood tests that can detect it, the International Headache Society has given a criteria to help your healthcare provider diagnose the disorder. 

It’s possible that you have vestibular migraine if you experience any of the following:

• You’ve had migraines in the past
• You’ve had at least 5 episodes of vertigo where you feel like spinning or moving. 
• Symptoms last between 5 minutes to 72 hours
• You have moderate to severe symptoms
• You experience on of the following symptoms in at least half of the episodes:
• Sensitivity to sound or light
• Seeing flashing lights (migraine with aura)
• Aggravation by routine physical activities
• Pulsing, one-sided, or moderate to severe headache

Doctors will usually order an MRI and check your hearing and balance to rule out vestibular migraine. The following conditions are similar to vestibular migraine:

• Meniere’s disease 
• Benign paroxysmal positional vertigo
• Brainstem stroke

Treatments for Vestibular Migraine

To reduce the intensity and number of episodes, people with vestibular migraines need to have a regular meal and sleep schedule, managing stress, regular exercise, and avoiding migraine triggers. 

The treatment for vestibular migraines are somewhat similar to other types of migraines. Since there is no specific medication for vestibular migraines, most healthcare providers will prescribe abortive medication that suppresses the vestibular system during an episode.

If you are experiencing frequent attacks, your healthcare provider can recommend one or more of the following medications:

• Serotonin  
• Beta-blockers
• Calcium channel blockers
• Topiramate
• Tricyclic antidepressants
• Antiseizure drugs

Migraine with Brainstem Aura

Migraine with brainstem aura or MBA is a rare subtype of migraine with aura that begins in the brainstem. It was previously referred to as basilar artery migraine or basilar migraine. 

This is usually accompanied by disorders of consciousness or symptoms like speaking and hearing difficulties, vertigo, and loss of muscle control. Most people with MBA sees lines or spots accompanied by abnormal flashes of lights. 

Most people who have migraine attacks with brainstem aura experience vertigo. It’s described as rocking, spinning, or pitching forward. This usually lasts for several minutes up to an hour. 

If the primary symptom of your migraine attack is vertigo that lasts for more than an hour or a few days, it’s often referred to as vestibular migraine. 

Studies show that migraine with brainstem aura only affect 0.04% of the general population and 10% of people with migraine with aura. Most patients with MBA have a family history of migraine and research shows that women are more at risk of developing this type of migraine than men. 

Symptoms of Migraine with Brainstem Aura

Just like any migraine, you’ll most likely experience the common symptoms of migraine with aura, such as:

• Seeing flashing lines, spots, or stars
• Temporary loss of vision or seeing “static”
• Feeling exhausted or weak
• Numbness in the face, head, or hands

Since the MBA begins in your brainstem, you may experience the following symptoms on one side or both sides of your body:

• Nauseous
• Feeling disoriented or confused
• Double vision 
• Vertigo 
• Difficulty in speaking or pronouncing words
• Extremely painful headache
• Changes in your hearing 
• Difficulty in controlling your muscles also known as ataxia
• Backing out 
• Losing consciousness

How is Migraine with Brainstem Aura Diagnosed?

Even though migraine with brainstem aura has been around for half a century, the cause is still unknown and the diagnosis is even questioned at times. There are no specific tests to diagnose migraine with brainstem aura. Instead, your healthcare provider will rely on your medical history and physical exam to assess your ability to think clearly, reflexes, physical strength, nerve function, and vision.

In 2018, the International Headache Society published specific guidelines for diagnosing migraine with brainstem aura. Before diagnosing MBA, two episodes must occur that includes two or more of the following symptoms:

• Tinnitus
• Impaired speech
• Vertigo
• Double vision
• Hearing disruption
• Inability to control body movements
• Losing consciousness

Also, some MBA symptoms can be serious conditions such as epilepsy, brain tumour, store, poor blood flow to the brain, and congenital defects. To rule out other conditions, specific tests might be needed. These are some tests that your healthcare provider may recommend:

• MRI of the brain - to rule out stroke
• CT scan - to rule out stroke
• EEG - to rule out seizure disorder
• Magnetic resonance angiogram
• Spinal tap (lumbar puncture)
• Specialised blood tests

Treatments for Migraine with Brainstem Aura

Dealing with MBA involves using medications and taking measures to prevent or reduce migraine attacks. The following medications are also used to treat other types of migraine headache symptoms which are also highly effective for migraine with brainstem aura.

• Pain medications
• Beta-blockers
• Antidepressants
• OnabotulinumtoxinA
• CGRP antagonists
• Anticonvulsants 

Some migraine medications such as triptans are not recommended for preventing migraine with brainstem aura. Triptans constrict your brain’s blood vessels. 

Here are some common abortive medications to reduce MBA symptoms:

• Antiemetics (anti-nausea)
• Nonsteroidal anti-inflammatory drugs 
• Small molecule CGRP antagonists

Hemiplegic Migraine

Hemiplegic migraine is a rare and serious type of migraine wherein individuals will experience headaches accompanied by weakness on one side of the body. Typical migraine with aura symptoms such as changes in speech, sensation, and vision are also experienced.  Motor weakness that are similar to stroke symptoms occur in hemiplegic migraines. 

There are two types of Hemiplegic Migraine:

1) Familial Hemiplegic Migraine

• FHM occurs in families where there may be a genetic mutation or anomaly. To diagnose FMH, there should be at least one first or second-degree relative that has been diagnosed with hemiplegic migraine.  FHM symptoms can start during childhood and adolescence. The symptoms may also decrease in time.
• Aside from genetic anomalies, stress, certain foods, or minor head injury can cause FHM.
• People with FHM due to a genetic anomaly, there is a 50% probability that it would be passed on to their children. 

2) Sporadic Hemiplegic Migraine (SHM)

• SHM occurs in an individual without a family history of hemiplegic migraine. However, they may or may not have a family history of migraine with aura. Sometimes, it can also overlap with FHM because a person diagnosed with SHM may be the first person to receive a diagnosis in the family. This doesn’t rule out the possibility that they have relatives who never experienced symptoms.

Symptoms of Hemiplegic Migraine

Here are some of the most common symptoms:

• Unilateral body weakness in the arms, legs, or face
• Visual disturbances
• Numbness on the face, arm, or leg
• Speech difficulties
• Headaches
• Clumsiness
• Confusion
• Headache
• Drowsiness
• Loss of consciousness
• Memory loss
• Sensitivity to sound or light
• psychosis

Here are some more severe symptoms to watch out for:

• Fever
• Seizures
• Coma

People with hemiplegic migraine may also experience neurological symptoms that last from one hour up to several days. But, most people resolve after 72 hours. Here are some symptoms:

• Sensory changes
• Language changes
• Involuntary eye movements
• Coordination difficulties

How is Hemiplegic Migraine Diagnosed?

Just like the previous subtypes of migraine with aura, your healthcare provider will examine you physically and family history. To be diagnosed with hemiplegic migraine, you need to have had at least two episodes. The individual must also have temporary symptoms including motor weakness, speech, vision, or senses.

Additionally, they should have at least two of the following:

• One o more symptoms on one side of the body only
• Two or more symptoms that occur in succession
• At least one neurological symptom that gradually spreads in 5 minutes or more
• Non-motor symptom lasts for about 5-60 minutes
• Motor symptoms last up to 72 hours
• Headache accompanied by sensory, visual, or motor symptoms within one hour

Your healthcare provider needs to rule out potential serious conditions before diagnosing hemiplegic migraine. Some potential causes include stroke, seizure, and transient ischemic attack.

Treatments for Hemiplegic Migraine

Having hemiplegic migraine can be distressing and scary. Proper diagnosis is needed to initiate the correct treatment to help manage and prevent attacks. Treatments for hemiplegic migraine involves preventive medications and pharmacological treatment. Individuals experiencing severe attacks may need hospitalisation and additional measures. 

Patients can also be treated with the same preventive and abortive medications used for migraine with aura except for agents that may exacerbate ischemia. Here are some medications that may be used:

• Beta-blockers
• Anti-seizure medications
• Tricyclic antidepressants
• Calcium channel blockers
• Antinausea medications 
• Intravenous verapamil

Nutritional Approaches

There are several supplements that can be helpful in helping with migraines.

Riboflavin 400 mg

Riboflavin or vitamin B2 keeps energy production run smoothly to help cells function and develop properly.It is also responsible for converting food into fuel. It also helps metabolise protein and fats. People who suffer with migraines show a glitch in the metabolic process. Riboflavin also helps in proper development of the skin, blood cells, lining of the digestive tract, and brain function. 

However, the human body is not capable of producing riboflavin, it is a so-called essential vitamin. You can get vitamin B2 from dietary supplements or food.

Riboflavin deficiency people often have high levels of homocysteine and migraines. Although there are limited studies on why Vitamin B2 helps in preventing migraines,  it is noticeable that those who have Vitamin B2 deficiency are more prone to having migraines. 

An analysis of multiple studies showed that participants who took 400 mg of vitamin B2 for 3 months showed reduced pain, frequency, and duration associated with migraine headaches.

Vitamin B2 can be found in foods such as:

• Nuts
• Milk
• Eggs
• Meat
• Green veggies
• Enriched flour

Forms of Riboflavin Supplements from Bespoke Biotics

• Migrasoothe-Pro - contains 400 mg of Riboflavin Vitamin B2 and 220 mg of L-Tryptophan. Enhanced with B6, B12 and Folic Acid. We include tryptophan to support serotonin level which are lower in Migraineur's. There is also  evidence indicating that B6, B12 and folic acid can be prophylactic for migraine auras. 

• Migrasoothe-B - contains 400 mg of Riboflavin Vitamin B2. Recommended for migraines, fatigue, and brain energy.

CoQ10

Coenzyme Q10 is a natural occurring substance found inside the human body. Cells use this substance to produce energy needed for maintenance and growth. It also helps in neutralizing harmful particles called free radicals—acting as an antioxidant.

CoQ10 deficiency is associated with different diseases such as cancer, Alzheimer’s, and heart disease. 

There are several factors that can lower the levels of CoQ10 in the body including:

• Ageing
• Genetic mutations
• Disorders of the mitochondria
• Taking statins or cholesterol-lowering medications

You can find CoQ10 in these foods:

• Oily fish
• Eggs
• Nuts
• Organ meats
• Whole grains

According to author Peter S. Sandor, ““A lack of cell energy in the brain may be a cause of migraine, CoQ10 may give a boost to those cells and help prevent migraine.”

A small trial was conducted in 2019 on women with migraines. Participants who took 400 mg of CoQ10 per day for three months showed a decrease in the duration, frequency, and severity of migraine attacks. 

Another study found that taking an addition of 100 mg of CoQ10 to your migraine medication daily reduced the severity of migraine attacks per month.

Researchers concluded that CoQ10 has a significant effect on reducing the frequency and duration of migraine. 

Some common side effects include:

• Diarrhoea
• Skin rash
• Stomach pain
• Vomiting

CoQ10 Supplement by Bespoke Biotics

Bespoke Biotics offers Triple Strength CoQ10 300 mg with Vitamin B1. Suitable for vegans and vegetarians. 

It is recommended to take 300 mg of CoQ10 with our Riboflavin 400 mg (Migrasoothe-B) daily to help prevent migraine attacks. 

Adults should take 1 capsule daily after meals. Do not exceed the recommended daily dose. 

Magnesium

Magnesium is an abundant mineral that maintains blood pressure, nerve, and muscle functions. It is also required in energy production, glycolysis, and oxidative phosphorylation. It is also involved in more than 600 processes in your body including:

• Gene maintenance - helps create and repair DNA and RNA
• Energy creation - helps convert food into energy
• Muscle movements - aides in muscle relaxation and contraction
• Protein formation - creates proteins from amino acids
• Nervous system regulation - regulates neurotransmitters

Low levels of magnesium in the body is linked to several diseases such as clogged arteries, hereditary heart disease, high blood pressure, osteoporosis, stroke, and diabetes.

Research has shown that people with recurring migraines have lower levels of magnesium than those who don’t have migraine attacks.  As a result, experts believe that magnesium plays an important role in treating and preventing migraines.

The British Association for the Study of Headaches recommends taking 400-600 mg of magnesium per day to prevent migraines. It’s best to take magnesium supplements for at least 3 months to find out if it works for you or not.

Here are some foods that are rich in magnesium:

• Almonds
• Pumpkin or squash seeds
• Low-fat yoghurts
• Tuna, mackerel, and Pollock fish
• Avocado
• Black beans
• Dark chocolate
• Bananas
• Figs 

Some side effects to take note of are diarrhoea, cramping, and nausea. This can mean you’re taking above the recommended dosage. 

Magnesium Supplements by Bespoke Biotics

Bespoke Biotics offer a Mag-Shield PRO Magnesium Citrate 500 mg supplement which is easier and faster to absorb compared to other magnesium supplements. One 500 mg capsule provides 150 mg active magnesium in a highly bioavailable form. 

Magnesium Citrate is one of the easiest forms of magnesium that the body can absorb so it is more effective than some higher dosed alternatives. 

Adults can take  2-4 capsules per day.  

To tackle migraine headaches of various descriptions magnesium should be combined with:

•  Migrasoothe-B or Migrasoothe-Pro 400mg of Riboflavin which is recommended by the National Institute of Clinical Excellence in the UK as well as American Australian and Canadian clinical bodies for reduction of migraine frequency. The strength of riboflavin is over 400 times typical High Street available doses. Many scientific studies have shown that lower quantities of riboflavin for example even 200 mg do not affect migraine at all. 
• Cor Shield 300Mg of Coenzyme Q10. CoQ10 Triple strength helps in converting nutrients into energy-producing adenosine triphosphate—which helps in fuel energy transfer within cells.

There are many other supplements which are also help but these are a formidable combination to start with. You can buy 60 days supply directly from Bespoke Biotics website. Simply take

• 2x Mag-Shield Magnesium capsules per day combined
• 1x Migrasoothe Riboflavin 400Mg capsule
• 1x Coenzyme Q 10 Capsule

Herbal Treatments 

- Feverfew

Feverfew has been used for centuries to treat migraines and other health problems. It is believed to reduce inflammation in the blood vessels in the head and treat fever. People took feverfew to relive pains and aches in the first century. 

Feverfew can be found worldwide and is prepared by drying the flowers, stems, and leaves. 

In 2002, a study was conducted to migraine patients. Patients randomly took the feverfew in three doses (2.08 mg, 6.25 mg, 18.75 mg) three times per day for twelve weeks and compared it to the placebo group. Researchers found out that those who took 6.24 mg of feverfew three times a day is effective in reducing migraine headaches.

It can cause minor side effects such as bloating, contractions in pregnancy, gastrointestinal symptoms, nervousness, headache, dizziness, trouble sleeping, menstrual changes, joint stiffness, tiredness, pounding heart, rash, weight gain.

- Ginger

Ginger is a tropical plant and has been used in herbal medicines in China for more than 2,000 years. 

The root of ginger has been used for numerous medical purposes including relieving stomach ailments, relieving nausea and migraine, arthritis, cold and flu symptoms, and neurological problems. 

In 2014, a clinical trial was conducted involving 100 participants who had acute migraine. They were randomly treated with sumatriptan (a drug used to treat migraines) and ginger powder. Those who took ginger powder showed a significant decrease in headache severity in less than two hours. Additionally, they experienced less side effects than those who took sumatriptan.

Ginger can be taken in the form of capsules and tea. You can also mix a quarter teaspoon of ginger powder with a glass of water. Chewing ginger candy is also effective in relieving headaches and migraines. 

 

Bespoke Biotics sell Migrasoothe + Herbs which contains  Riboflavin + Feverfew + Ginger

 

- Peppermint

Peppermint leaves and essential oils are used as a herbal medicine to relieve headaches, toothaches, spasms, nausea, and gastrointestinal problems. It is also used in foods and products such as toothpaste, cosmetics, and chewing gum. It grows throughout Europe and North America. 

Peppermint oil and its active ingredient—menthol—is available in capsule form and teas. Menthol helps in relaxing the muscles and easing pain. Some people use it as a dietary supplement and essential oil applied directly to the skin. 

In a 2010 study, experts found that menthol in a 10% solution was effective at relieving migraine pain and nausea when applied to the temples and forehead.

Although there are only limited studies about its clinical effectiveness, topical peppermint oil is a good herbal remedy to relieve migraine headaches. Peppermint oil has a cooling or tingling effect that can cause a numbing effect.

Peppermint oils are considered safe, but possible side effects include:

• Heartburn
• Rash
• Allergic reaction 

As there are limited studies on peppermint oils, it shouldn’t be applied to the chest of infants or children as it can cause serious side effects to children when inhaled.

 

Disclaimer
Information provided by this article and our company is not a substitute for direct, individual medical treatment or advice. It is the responsibility of you and your healthcare providers to make all decisions regarding your health.