Which Type of Migraine Do You Have? Treatment Explained.

The International Classification of Headache Disorders, third edition (ICHD-3), defines migraine not as a single disorder; instead, it divides it into two broader categories based on the underlying causes of the headache.

Migraine without aura indicates that the headache is not caused by any neurological conditions, and migraine with aura is further split into typical aura, brainstem aura, and hemiplegic subtypes, as well as chronic migraine and a set of episodic syndromes that includes menstrual and vestibular migraine, each with distinct diagnostic criteria. 

The mechanism driving each type differs enough that first-line treatment differs by type, and evaluating any complementary approach, including aromatherapy, against the condition as treating it as a single one produces a misleading answer. This article works through the major types of migraine and states what the evidence supports each and closes with an analytical look at where the specific aromatherapy blend of Graine Out fits and where it does not.

Chronic migraine, defined as headache on 15 or more days per month with migrainous features on at least 8 of those days, is treated with a different first-line approach than episodic migraine. CGRP-targeted monoclonal antibodies, including erenumab, fremanezumab, galcanezumab, and eptinezumab, are now recommended as first-line preventive treatment by the 2024 American Headache Society consensus statement, with long-term studies confirming sustained efficacy and tolerability compared to non-specific oral preventives (Nicol & Burkett, 2025). This is a meaningful analytical distinction from episodic migraine: the treatment for this condition starts with a targeted biologic, not an oral abortive. Aromatherapy has no evidence of altering attack frequency at this level, and the honest, defensible role for it in chronic migraine is symptomatic and adjunctive. Alongside, not instead of, CGRP-targeted prevention.

Menstrual migraine is mechanistically distinct from the baseline pathway, driven by the premenstrual drop in estrogen, known as the estrogen withdrawal hypothesis. Falling estrogen reduces activation of the µ-opioid pain-suppression system and alters serotonergic tone, while also increasing susceptibility to prostaglandin-driven neuroinflammation that facilitates CGRP release (Seo, 2024). Perimenstrual attacks are documented to be more disabling and longer lasting than non-menstrual attacks, and interictal CGRP concentrations are elevated in women with menstrual-related migraine during menstruation specifically (Seo, 2024). 

Acute treatment principles for this condition mirrors those for non-menstrual attacks, but short-term preventive therapy timed to the perimenstrual window is often needed given the predictable hormonal trigger (Seo, 2024). Because this type shares the same downstream CGRP and serotonin pathway as migraine without aura, the lavender and general aromatherapy evidence discussed above is mechanistically relevant here too, though no source reviewed for this article tested aromatherapy in this condition specifically, so this should be read as a plausible extension, not direct evidence.

Vestibular migraine involves episodic vertigo or dizziness lasting minutes to days, with at least half of episodes associated with migraine features, in a patient with a current or past history of migraine with or without aura. Its mechanism is understood to involve the same trigeminovascular and serotonergic systems, extended to vestibular pathways in the brainstem and inner ear. 

No source used in this article, or identified in the broader search for this piece, tests aromatherapy specifically in vestibular migraine. This is stated plainly rather than papered over: the general olfactory-limbic mechanism by which aromatherapy engages stress and pain pathways (Sattayakhom et al., 2023) is plausible background support, but there is no direct evidence for this type, and anyone experiencing vertigo alongside the condition should be evaluated medically rather than relying on aromatherapy as a primary approach.

Before recommending aromatherapy for any type, it is worth stating what happens when the individual positive trials cited above are pooled. A 2023 systematic review and meta-analysis of seven randomized controlled trials, 558 participants total, found no statistically significant difference between essential oils and placebo for migraine attack frequency or severity when the data is combined (Murtey et al., 2023). This does not contradict the individual's findings; it reflects the heterogeneity of oils, doses, and delivery methods across small trials. The analytical conclusion is that aromatherapy shows real, mechanism-consistent benefit in specific, well-designed trials, particularly for lavender in migraine without aura and menstrual-adjacent presentations, while lacking support as a uniformly effective treatment across migraine as a category.

Migraine is not one problem, and neither is its treatment. The evidence for aromatherapy suggests that lavender's action on the serotonin transporter is a genuine, receptor-level finding. But it is concentrated in migraine without aura and, by mechanistic extension, menstrual migraine, and it thins out considerably for chronic, hemiplegic, and vestibular presentations. Matching the type of treatment, rather than treating migraine as a single condition, is the difference between a defensible recommendation and an overstated one.

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Seo, J.-G. (2024). Menstrual migraine: A review of current research and clinical challenges. Headache and Pain Research, 25(1), 16–23. https://doi.org/10.62087/hpr.2024.0004