Acephalgic migraine, a silent attack
Migraine aura without headache, also known as a acephalgic migraine or “silent migraine”, is a type of migraine in which a person experiences neurological symptoms, such as aura, without the headache traditionally associated with migraine attacks. People may notice visual disturbances such as shimmering lights, zig-zag lines, temporary blind spots, or flashing colors for 5 minutes up to an hour. Others experience sensory changes, dizziness, brain fog, nausea, or difficulty speaking. Because the hallmark headache is missing, many people don’t realize they’re having a migraine at all.
What Causes a Silent Migraine?
Acephalgic migraine is believed to result from abnormal electrical activity in the brain; particularly a phenomenon called cortical spreading depression.1 Triggers can be the same as with typical migraine: stress, poor sleep, dehydration, hormonal shifts, certain foods, bright lights, weather changes, or excessive screen time. Some individuals experience silent migraines as they age or after years of more traditional migraine attacks. Understanding personal triggers can be an important part of reducing the frequency of these episodes.
Treatment Options and When to See a Specialist
Even without head pain, migraine aura without headache can be disruptive and frightening. For most, these attacks are not frequent and medication is not necessary. Acute medication is typically not prescribed, because attacks typically only last up to an hour. For those with frequent episodes, preventive treatment with magnesium, topiramate, or lamotrigine can be used. Supplements, lifestyle adjustments, and trigger management can also be employed. Because silent migraine symptoms may overlap with more serious conditions, such as transient ischemic attack (TIA), retinal issues, or seizures, it’s important to see a headache specialist for a thorough evaluation, especially if symptoms are new or changing.2 Interested in an evaluation? Click here to book a consultation now!
References:
1. Shah DR, Dilwali S, Friedman DI. Migraine Aura Without Headache [corrected]. Curr Pain Headache Rep. 2018 Sep 17;22(11):77
2. Kunkel RS. Migraine aura without headache: benign, but a diagnosis of exclusion. Cleve Clin J Med. 2005 Jun;72(6):529-34.