IME, typical migraine symptoms typically present with typical migraines.

IOW, atypical migraines don't always present with typical migraine symptoms, e.g. not all migraines cause pain (these are sometimes known as silent or acephalgic migraine), and not all migraines are in the head (e.g. abdominal migraine).

The typical ones are easy; it's the atypicals that can slip through the cracks and go undiagnosed (and prove more difficult to treat).

The last time I changed PCPs, and the doctor was entering my various DXs into his computer, he stopped when he got to migraines.

"Hmmm," he said, "There are 30 different kinds of migraines here, and yours isn't listed. Ah, here it is... 'None of the above'."

Thanks for those links. I haven't had time to peruse them, but I've bookmarked them for later. Off hand they appear to be more comprehensive (albeit somewhat confusing) than the other sites I use. The litmus test will be if they have mine.

Doc

Right. To clarify, the "typical" sx I gave specifically refer to Migraine without Aura as defined by the IHS, as per the link following that paragraph. That is the simplest type of migraine-with-head-pain that they define, and many of their other diagnoses refer back to this headache type.

I do not know if the IHS criteria are those used in the US. Any diagnostic criteria, however, serve as minimal guidelines; they are not intended as descriptive references and cannot cover every possible experience.

Yes, I myself get acephalgic migraines sometimes. The IHS codes these as a form of Migraine with Aura. Abdominal migraines are coded under childhood syndromes, but the text specifies that they occur mainly in children, suggesting that an adult can also receive the dx.

Haha. I've seen these catch-all diagnoses for other illnesses too. They are provided precisely so physicians can decide if an individual warrants a certain diagnosis even though he or she does not fit nicely into one of the specific diagnostic buckets, as there will never be enough diagnostic buckets to fit each singular case.

Enjoy!

Not sure what your defining sx are... I'd be curious if you find yours. In regard to the mixed/tension aspect, though, I'm pretty sure that is not coded specifically. I believe the working definition of such is a headache which meets criteria for both migraine and tension type.

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On another note, You've mentioned you have difficulty peeling apart the tension/migraine headaches and treating accordingly. You've probably tried lots of things so I don't know if my experience can be of any use to you:

For clearly mixed headaches, I treat both the tension and the migraine.

Sometimes, I get severe, unilateral tension in certain back/shoulder/neck muscles and after about 12 hours of that I get a headache whose pain quality varies. The neck/back pain persists, sometimes to the point of causing neuralgia right the way down my arm. These caused me a lot of confusion. Thinking that there was mostly a tension issue, I would take myorelaxants, wind up with a wicked headache, and end up having to take huge amounts of NSAIDs. For a while I just took less NSAID to try to cover my bases, but this is undesirable. At some point I discovered that, most of the time, zolmitriptan will not only kill the migraine but also relieve the tension. If I take the Zomig early at the first hint that some stiffness is producing a headache, I don't usually need other medications. YTMV (Your Triptan May Vary ....if indeed you use them for your type of headache.)

BTW, is your back doing better (recalling the herniated disc)?

waves