Silent Migraine (Typical Aura Without Headache)

What is a silent migraine?

Silent migraines are migraines without the characteristic throbbing headache. With a silent migraine, you experience aura, which are changes in your senses (sensory issues).

Also known as migraines without headache, typical aura without headache, or acephalgic migraine, silent migraines affect about 5% of people with migraines. Even though they don’t cause a debilitating headache, the condition can disrupt your daily life. Treatment is medication to keep the condition from happening.

What are the symptoms of silent migraines?

Silent migraine symptoms come on within minutes and may last up to an hour. Vision issues are the most common. In silent migraine, you may see bright lights, wavy or jagged lines, flashing dots or sparkles. These lights, spots and sparkles seem to start in the center of your line of sight and spread to both sides. Silent migraines may also cause blind spots (scotomas).

Other symptoms include:

• Numbness or tingling sensation (paresthesia): The tingling or numbness may start in one hand and move up your arm to your face, lips and tongue.
• Difficulty speaking (aphasia): You may sound as if you’re slurring your words or mumbling.
• Tinnitus: You hear ringing or buzzing in your ears.
• Dizziness: You may feel like your head is spinning or you’re going to faint.

Some silent migraine symptoms are similar to other more serious medical conditions. So, don’t hesitate to get immediate medical attention if you have sudden, significant symptoms like difficulty talking, numbness and weakness.

What are silent migraine warning signs?

Silent migraines may not cause warning signs. In some cases, like a migraine with a headache, silent migraines can have phases. Silent migraine warning signs develop in the prodrome phase. This phase can start up to 24 hours before you experience aura. Prodrome symptoms include:

• Irritability.
• Feeling depressed.
• Fatigue.
• Yawning.
• Peeing more than usual.
• Trouble sleeping.
• Craving specific food.
• Nausea.
• Increased sensitivity to lights or sound.
• Difficulty concentrating, reading or speaking.
• Neck pain or stiffness.
• Hyperactivity.

Aura is the second phase of a migraine, followed by the postdrome phase. While not everyone with silent migraine experiences this, the postdrome phase is known as a migraine hangover because the symptoms are like hangover symptoms.

What causes silent migraines?

Researchers link aura with migraine to cortical spreading depression (CSD). CSD happens when brain cells in your cerebral cortex become hyperactive and then become inactive in a wave that spreads across your cortex. Researchers believe genetic mutations may cause CSD that leads to aura. They do know certain factors (triggers) increase the risk you’ll have a silent migraine. Like migraines, silent migraine triggers include:

• Emotional stress.
• Hormonal changes.
• Changes to your sleep.
• Weather condition changes.
• Exposure to bright lights, loud sounds or strong odors.

What are the complications of silent migraines?

Studies show people who have silent migraines have some increased risk of transient ischemic attack.

How are silent migraines diagnosed?

Healthcare providers diagnose silent migraine by doing physical examinations. They may do neurological examinations to rule out other conditions that may cause silent migraine symptoms. They’ll ask you to:

• Describe what you see during your experience. They’ll ask you to draw a picture of what you remember seeing.
• When symptoms started and how long they lasted.
• How often you experience specific symptoms.

What are treatments for silent migraines?

The best way to treat silent migraines is to know what triggers them. Your healthcare provider may ask you to track what you did or experienced before you noticed silent migraine warning signs. For example, they may ask you to note:

• What you ate.
• What you were doing.
• If you were feeling stressed.

Getting ahead of a silent migraine during the prodrome phase may reduce how long you have aura or help with other symptoms. For example, taking pain medication at the first sign of aura may reduce the risk of nausea and sensitivity to light or loud noises. Researchers are investigating several medications that may prevent a silent migraine.

Can silent migraines be prevented?

There’s no way to prevent a silent migraine. But there are steps you can take to ease prodrome symptoms:

• Take a break: Lying down in a quiet, dark room can help you avoid environmental triggers like light and sound. Resting and relaxing may also reduce the stress that can trigger a silent migraine.
• Stay hydrated: You may pee more often during the prodrome phase, so be sure to drink lots of water.
• Don’t skip meals: If you’re feeling nauseated, try eating small amounts of food. But avoid foods that trigger migraines.
• Manage neck pain: A heating pad may help with neck pain and stiffness.

What can I expect if I have silent migraines?

There’s no cure for silent migraines but knowing what triggers them may help you manage symptoms so they don’t disrupt your life.

When should I see my healthcare provider?

Contact your provider if:

• You’re having silent migraines more often.
• Your symptoms get worse. This includes prodrome phase symptoms as well as aura that you experience during a silent migraine.

When should I go to ER?

Some silent migraine symptoms are like stroke symptoms. Go to the emergency room if you have symptoms like difficulty talking or numbness and weakness that feel more intense than what you typically experience with a silent migraine: