If you get migraines, you may know how painful the condition can be.
Some people develop migraines that don’t cause pain. These are often called “silent migraines” or acephalgic migraine. Even though they don’t cause physical pain, silent migraines may trigger other symptoms that can be debilitating. The terms “silent” and “acephalgic” are descriptive terms, not diagnostic, used to describe a migraine attack without the headache phase of the attack – ie a migraine with no headache. These terms are referring to an individual phase of a migraine attack.
Your doctor may suggest medications or devices that can treat the problem. You can also help yourself by avoiding your migraine triggers.
Typical aura without headache, despite a lack of head pain, can still be disabling for those who live with it. It also has its own set of considerations during diagnosis and treatment.
The typical phases of a migraine attack may include:
People typically associate migraines with the third phase of head pain. However, some migraine sufferers experience a type of migraine that has many migraine symptoms, yet the head pain is absent. The terms silent migraine and acephalgic migraine refer to a migraine attack which skips the third phase of headache.
Migraine sufferers may experience only silent migraine attacks, while others may have some migraine attacks with head pain and others without. Although silent migraines may occur at any age and in those who never experienced migraines before, most often silent migraines pop up in people who suffered from migraines with aura when they were younger.
Because it’s not an official diagnosis, a silent migraine can have multiple meanings. Someone may get that “I’m going to get a migraine” feeling (called a prodrome), but the aura or headache never shows up. That day you might feel foggy, your coordination may be off, or you may feel uneasy. This can be a silent migraine.
Other Names for Silent Migraine
People may use many different terms to refer to a migraine attack without a headache.
- Acephalgic migraine
- Amigranous migraine
- Migraine aura without headache
- Migraine equivalent
Types of Silent Migraine
Silent migraine attacks may occur in people who experience any of the migraine types recognized by the International Headache Society, including:
- Migraine without aura
- Pure menstrual migraine and menstrual-related migraine
- Migraine with aura
- Familial hemiplegic migraine and sporadic hemiplegic migraine
- Basilar-type migraine
- Common Childhood Precursors of Migraine
- Cyclical vomiting
- Abdominal Migraine
- Benign paroxysmal vertigo of childhood
- Retinal Migraine
The Effect on Patients
Research is a bit limited, but we know that migraine presents patients with a high burden from different symptoms. For a patient who’s having a visual aura that comes on in situations like driving, it can be very disconcerting. It affects day-to-day functioning, even if a headache and other features aren’t there. This is especially true if it’s the first time it happens or there’s a change in how it presents. Typical aura without headache—the “silent” migraine—can be quite scary.
—Jennifer Robblee, MD, is part of the Mayo Clinic in Scottsdale, Arizona
When symptoms of a migraine creep up, but you don't have the telltale head pain, you may be confused.
Classic migraines may be accompanied by symptoms other than a headache. Some people experience visual disturbances and sensory symptoms known as “aura” before pain hits.
People experiencing silent migraines may experience all the symptoms of a migraine attack without head pain. Some of these symptoms include:
- Speech disturbance
- Migraine aura
- Vision changes
- Seeing flashes or flickering lights
- Seeing zigzag lines or waves, also called fortification illusions
- Seeing spots, stars, halos, circles, lines, shimmering, other shapes or colors
- Blurry vision
- Loss of vision
- Cloudy vision
- Other visual disturbances
- Seeing three-dimensional effects
- Seeing dark areas
- Migraine sensory aura symptoms such as
- Tingling or numbness
- Feeling pins and needles
- Odd sensations in a body part
- Clumsiness or weakness in the limbs
- Other symptoms
- Change in mood
- Hearing loss
- Abdominal pain
Because many of the symptoms of silent migraines are the same as the symptoms for stroke or a transient ischemic attack (TIA), sometimes called a mini-stroke, it is very important to see a medical professional immediately to diagnose the cause of the symptoms. Ruling out stroke and other more serious disorders is crucial since the typical migraine head pain is not present.
You can have symptoms that go along with any phase of a migraine, but without the classic pain around your temples.
During the phase that warns you a migraine is coming, called the prodrome phase, you could:
- Get "hyper" or cranky
- Have food cravings
- Be tired and yawn more
- Feel stiff, especially in your neck
- Need to pee more often
- Get constipated or have diarrhea
Next, the aura phase usually lasts about an hour. It's best known for its unusual visual symptoms, such as seeing:
- Wavy or jagged lines
- Flashing lights
- Dots or spots in your vision
- Blind spots
- Tunnel vision
- Trouble hearing, or hear things that aren't there
- Strange smells or tastes
- Numbness, tingling, or a pins-and-needles feeling
- Trouble remembering or saying a word
Even though your head doesn't hurt, a silent migraine may affect your body in other ways:
- Upset stomach or vomiting
- Hot flashes and chills
- Stuffy or runny nose
- Dizziness or spinning (called vertigo)
- Sore neck or jaw
- Sensitivity to light, sounds, smells, touch, or motion
Silent migraines occur when you have aura symptoms without a headache. They typically last from a few minutes up to an hour. Some people have chronic migraines that last for days, weeks, or months, but this isn’t typical for silent migraines.
Afterward, you may feel wiped out and have the blahs for as long as a day.
Not all migraine attacks follow the same pattern. Even for the same person, the symptoms can be unpredictable.
Because migraines are usually associated with significant pain, silent migraines may seem like a paradox. They’re thought to have a genetic cause, but it’s unclear exactly why they occur. Migraines may be caused by the brain’s difficulty adjusting to sensory stimulation such as lights and noise. Changes in chemicals and blood vessels in the brain may also be factors.
Over time, most people figure out what triggers their migraines. The triggers may be environmental, related to food, or physiological. There are hundreds of potential migraine triggers such as:
- Bright lights
- Fermented foods
- Caffeinated drinks
- Barometric changes
- Chemical preservatives, colorings, and flavorings
- Stress,either physical or emotional
- Neck problems
- Pickled foods
- Sinus problems
- Foods or drinks with the amino acid tyramine, such as red wine and aged cheese
- Too much sleep
- Too little sleep
- Changes in your hormone levels -- during menstruation, pregnancy, or menopause, or when taking birth control pills -- may affect women.
- Your general well-being is also important.
Some medications may also cause migraines such as oral contraceptives and medications that open the blood vessels, or vasodilators.
Pain and Aura Causes
Researchers are now looking at aura and pain as two distinct things.
In the past, experts thought migraine was mainly a problem with blood flow in your brain. Now they believe the headaches involve the way nerve cells are firing in your brain and how that activity relates to the blood flow.
Aura appears to be a case of too much stimulation of the nerve cells and then a drop-off of activity in the brain. The decrease spreads across the top layer, or cortex, of your brain. It often travels from the visual part of the brain (occipital lobe) to the body sensation part of the brain (parietal lobe) to the hearing part of the brain (temporal lobe). This mirrors the visual, sensation, and hearing symptoms common to migraine.
What are the Risk Factors?
Your migraine risk, silent or otherwise, is higher if you:
- have a family history of migraines
- are under age 40
- are a woman
- are menstruating, pregnant, or going through menopause
Aura symptoms may mimic symptoms of other serious conditions such as ministrokes, strokes, and meningitis. For this reason, you shouldn’t self-diagnose a silent migraine. If you experience signs of aura for the first time, contact your doctor so that you can get a diagnosis.
Your doctor may be able to diagnose silent migraines based on your family history and a physical exam. If the symptoms are severe or new, they may order tests such as:
- blood tests
- CT scans
- MRI scans
- a spinal tap
In rare cases, your symptoms could be a sign of a different, more serious medical problem, such as a stroke or bleeding in the brain. To rule these out, your doctor may want to do more tests, such as a CT scan or MRI, or have you see a specialist called a neurologist for an exam.
If your migraines are infrequent, short in duration, and not severe, you may not need treatment. If they often happen and impact your ability to perform daily tasks or enjoy life, you should consider treatment options.
There’s no cure for migraines, but medication can help control symptoms. Treatments for silent migraines are the same as those for migraines with headaches.
Over-the-counter medications, such as the following, may help treat the symptoms of acute migraines.
If you experience migraines often, you may be advised to take preventive medications.
More than 100 medications can treat migraines. Be prepared to try different drugs to find the right one for you. Tell your doctor about all prescription and over-the-counter medicines you take to avoid problems with how any of them work and side effects.
Some prescription migraine treatments have side effects. For this reason, some people try alternative treatments before prescription drugs. Alternative options may include:
- massage therapy
- behavioral therapy
These treatments are often effective in easing stress, which can be a migraine trigger. They may also relieve acute episodes.
Once you figure out your triggers, try to stay away from them. If your symptoms are severe or regular, your doctor may suggest medication or a device to help prevent your migraine headaches.
Eat well, get plenty of rest, exercise most days, and find ways to manage your stress.
Have a plan in place
The first time you have an aura can be frightening—you have no clue what’s going on. If you get auras with or without headaches or “have a feeling” one is coming on, you should have a treatment plan in place with your doctor. Having your medications readily available is the best be-ready strategy, he says.
Silent Migraines Prevention
Your first step in preventing silent migraines is to identify your triggers. To do this, keep a migraine diary and write down when each migraine occurred, how long it lasted, and what you were doing before and when it struck. Be sure to note any foods or beverages you consumed, as well as any medications you took before the migraine began.
Once you’ve identified your triggers, you should avoid them. This may mean modifying your diet or avoiding noisy social situations.
If stress is a trigger for you, try practicing stress management techniques such as writing in a journal, meditating, or doing exercises such as yoga.
Take these steps to get on a regular sleep schedule and prevent insomnia:
- Go to bed at the same time each night.
- Avoid caffeine and other stimulants.
- Keep your bedroom cool and dark at night.
- Consider investing in a fan or white noise machine to block out noises that may keep you awake.
If you’re a smoker and get migraines, you should try to quit. A study published in Neurology found an increased risk of stroke in older smokers who have migraines.
Just because your migraine is over doesn’t mean you have total relief. Following a migraine, you may also have what is called postdrome symptoms. “The day after a migraine, while you may not have much of a headache, you may feel hungover, washed out, or can’t think as sharp,” explains Dr. Rothrock. This phase may be another facet of “silent migraine.”
Get the Right Care
Only half of the migraine sufferers get an actual diagnosis, and only half of those are prescribed treatment by their physician. Your primary care physician is a great person to start with, but you’ll probably need to see a headache specialist. .A headache clinic or a neurologist specializing in headache management can help. members of the foundation.