Throbbing head pain is the first thing most people think of when they hear about migraines. It’s the most common and debilitating symptom for most types of migraine and is often accompanied by sensitivity to noise and light, nausea and fatigue.
Yet, for a lesser-known type of migraine, people can experience all the excruciating symptoms of a migraine — without the painful headache.
Silent migraines, also known as migraine aura without headache, trigger intense visual auras or sensory disturbances.
Like migraines, aura can be equally disruptive and excruciating. Since people with these types of migraines don’t experience typical head pain, the symptoms can be easily overlooked or mistaken for other issues, like stress.
“People use the term ‘silent migraine’ all the time, but there is nothing silent about them,” says Dr. Lauren R. Natbony, medical director of the Integrative Headache Medicine of New York and assistant clinical professor of neurology at the Icahn School of Medicine at Mount Sinai in New York. “This type of migraine is no less debilitating even without experiencing serious head pain so using the term ‘silent’ perpetuates a harmful stigma.”
[SEE: Best Foods to Eat — and Avoid — for Migraines.]
Phases of a Migraine
A migraine aura without headache follows the four phases of a migraine attack:
— Prodrome: This signals that a migraine is coming. It can begin several hours or days before the aura or attack phase. Commonly reported symptoms include fatigue, food cravings, irritability, frequent yawning and increased thirst.
— Aura: This typically lasts up to an hour and is characterized by reversible and temporary neurological symptoms, such as visual, auditory, speech and other sensory disturbances.
— Attack: Symptoms can include sensitivity to light or sound, nausea, vomiting and throbbing head pain associated with migraines.
— Postdrome: This is also called the “migraine hangover,” as symptoms may include exhaustion, body aches or trouble concentrating.
“These patients may not have an attack phase with head pain, but at that time, they can still experience the nausea, vomiting and sensitivities to light and sound common during that phase,” says Dr. Christina Graley, a specialist in headache medicine and an assistant professor of neurology at Johns Hopkins Bayview Medical Center in Baltimore, Maryland.
[Read: Vitamins for Stress: Do They Work?]
What Is an Aura?
Migraines come in two forms: with and without aura. An aura is a sensory disturbance that can range from seeing sparks, bright dots or stars. According to the Mayo Clinic, an aura typically occurs within an hour leading up to head pain but subsides shortly afterward.
A migraine aura may include:
— Blurry vision or seeing spots, zig zags or flashes.
— Temporary vision loss.
— Dizziness.
— Numbness or tingling in the fingers or body.
— Ringing in the ears, otherwise known as tinnitus.
— Difficulty speaking or slurring words.
[READ: What to Do About Retinal Migraines.]
Risk Factors for Migraines
There are several possible risk factors for migraine headaches without aura:
— Genetic and environmental factors: Migraines, including migraine aura without headache, have been shown to have both genetic and environmental risk factors. Because migraines are hereditary, the risk of migraines has been shown to increase by 34% to 64% based on family history.
— History of migraines: If you repeatedly suffer from migraines in any form, you’re likely to experience migraine aura without a headache. In an October 2018 study published in the journal Current Pain and Headache Reports, researchers noted that migraine aura without headache occurs exclusively in 4% of migraine patients.
— Sex and hormonal changes: Women are two to three times more susceptible to getting migraines. Migraines have been tied to hormonal changes during menstrual cycles in more than half of women between the ages of 18 and 60.
Typical Triggers and Causes
Migraine aura without headache can be triggered by several common factors, include:
— Bright or flashing lights, loud noises or certain smells.
— Certain medications, such as oral contraceptives or vasodilators.
— Dehydration.
— Eye or neck strain.
— Stress.
— Weather changes, especially changes in barometric pressure.
Here are a few key details to record in a journal:
— When and where each attack occurred.
— How you were feeling before it began.
— If applicable, where you are in your menstrual cycle.
— What you ate and drank that day.
— Anything unusual that happened beforehand.
Medication and Management
Although there are several over-the-counter drugs for migraine relief, there are currently no medications approved by the Food and Drug Administration specifically for migraine aura without headache. Many medications take longer to work than the aura’s duration. However, accompanying symptoms — like nausea — can be treated providing some relief.
“Migraine aura without headache is sometimes hard to treat because they are unpredictable,” says Dr. Teshamae Monteith, chief of the headache division and associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami.
The best way to treat the condition, he says, is by starting migraine preventative therapies, such as anti-hypertensives, antidepressants and anti-migraine medications:
— Antidepressants: These medications primarily treat depression, but some antidepressants — such as Elavil and Effexor (venlafaxine) — may reduce migraine frequency by regulating certain brain chemicals, namely serotonin, norephinephrine and noradrenaline.
— Beta blockers: Originally developed to treat high blood pressure and heart failure, beta blockers slow down your heart rate and lower blood pressure. The two most common beta blockers used for migraine prevention are Toprol XL (metoprolol) and Inderal (propranolol).
— Calcitonin gene-related peptide (CGRP) inhibitors: These are the newest class of drugs to treat migraine drugs approved by the FDA within the past few years. These medicines work by blocking the CGRP receptor pathway, which plays a role in pain modulation. Studies show the drugs are safe and effective, typically alleviating symptoms within one to two hours. The FDA approved rimegepant (Nurtuc) for both acute and preventative treatment of migraines. Another CGRP inhibitor, ubrogepant (Ubrelvy), is approved for treating migraines with or without aura, but is not indicated for use as a preventative migraine treatment.
“These newer targeted therapies that block CGRP or its receptor have been shown to be effective for migraine aura and likely to also help migraine aura without headache,” Monteith says.
The symptoms of a migraine aura without headache can be similar to a stroke or transient ischemic attack. It’s important to see a doctor promptly if you have not had these symptoms before or if they suddenly increase in frequency or intensity.
Migraine with aura increases the risk of stroke and can present like a stroke.
“It is important to investigate for other causes of transient neurologic symptoms when patients have vascular risk factors like high blood pressure, diabetes or smoking history,” Graley says. “This is especially true when patients are over the age of 40 and do not have a history of migraine.”
More from U.S. News
Best Foods to Eat — and Avoid — for Migraines
How to Describe Medical Symptoms to Your Doctor
What Is a Silent Migraine? originally appeared on usnews.com
Clarification 11/22/22: A previous version of this article did not include Dr. Teshamae Monteith’s full name and title.
Update 03/24/23: This piece was previously published at an earlier date and has been updated with new information.
