A woman aged 44 had recurrent migrainous scintillating scotomas without headache one or more times daily beginning before the age of 7. Spells were brought on by hunger, anger and regularly by straining to have a bowel movement. At age 44, while straining, she experienced a sharp pain in the head, a buzzing sound, virtual blindness and numbness of the left side. A left homonymous hemianopia persisted. During convalesence she experienced unusually vivid hallucinations in the hemianopic field and on phenytoin sodium therapy two sets of hallucinations ran at the same time. The head pain of this type of “catastrophic migraine” may be a third type of migraine pain.