The International Classification of Headaches (ICHD-3) includes an appendix with several variants for migraine, including:
- Facial migraine
- Carotidynia
- Contact point headache
- Sinus headache
- Menstrual migraine
¶ Examples of migraine variants
¶ Facial migraine:
- Throbbing headache
- Located in frontal, parietal or temporal areas (V1)
- Located in V2 or V3 distribution
- Nause and/or vomiting
- Photophobia and phonophobia
The relationship of the anatomical area with the related vessel is shown below:
¶ Carotidynia
- Tenderness in the carotid artery
- Deep, dull pain
- Cervical pain
- Doppler is normal
¶ Contact point headache
- Pressure in the nasal cavity
- Nasal deviation with intranasal contact of mucosal surfaces
- Periorbital and medial canthus and temporozigomatic region
- Requires imaging
- Pain decreases with topical anesthetic
¶ Sinus headache
- Located in frontal and/or maxillary sinus area
- Rhinosinusitis is ruled out
¶ Menstrual migraine
- The role of falling in estrogen levels is believed to increase the susceptibility of blood vessels to prostaglandins, which have been implicated in neurogenic inflammation.
- Fluctuations of ovarian steroid hormone levels modulate calcitonin gene-related peptide in the trigeminovascular system.
- Gonadal hormones modulate cortical spreading depression susceptibility in animal models.
- The treatment is divided into acute, short-term prophylaxis, and daily prevention.
- The best-studied acute treatments are triptans. For acute treatments, rizatriptan has the best overall evidence.
- For short-term prophylaxis, triptans, non-triptans, or combinations are used. For short-term prevention, frovatriptan, zolmitriptan, or naratriptan, as well as magnesium, estrogen, naproxen sodium, or dihydroergotamine may be useful.
- Some preventive medications may be used daily.
- Many anti-epileptic medications used in migraine prevention can affect the efficacy of oral contraceptives and hormonal treatments, so caution is indicated when these are used.
¶ References
Lambru G, Elias LA, Yakkaphan P, Renton T. Migraine presenting as isolated facial pain: A prospective clinical analysis of 58 cases. Cephalalgia. 2020 Oct;40(11):1250-1254. doi: 10.1177/0333102420933277. Epub 2020 Jun 17. PMID: 32551980.
La Mantia I, Grillo C, Andaloro C. Rhinogenic Contact Point Headache: Surgical Treatment Versus Medical Treatment. J Craniofac Surg. 2018 May;29(3):e228-e230. doi: 10.1097/SCS.0000000000004211. PMID: 29283946.
Kirsch CFE. Headache Caused by Sinus Disease. Neuroimaging Clin N Am. 2019 May;29(2):227-241. doi: 10.1016/j.nic.2019.01.003. Epub 2019 Feb 21. PMID: 30926113.
Cupini LM, Corbelli I, Sarchelli P. Menstrual migraine: what it is and does it matter? J Neurol. 2021 Jul;268(7):2355-2363. doi: 10.1007/s00415-020-09726-2. Epub 2020 Jan 28. PMID: 31989282.