An Overview of Silent Migraines

Acephalgic migraines are characterized by the lack of headache

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Acephalgic migraine, or "silent migraine," is a form of migraine that occurs without an actual headache.


There are four phases of a migraine attack. While an acephalic migraine can go through the prodrome phase (when symptoms warn of an impending attack), the aura phase (visual disturbances that precede an episode), and the postdrome (or post-headache) phase, it skips the headache phase, which is considered the hallmark symptom of all other types of migraine.

Man experiencing migraine.
Ellen Lindner / Verywell

Because of this, those with silent migraine usually do not have the one-sided head pain that other migraineurs do. They also are less likely to experience symptoms like sensitivity to light, sound, and odors at the height of their episodes.


5 Types of Migraine Auras Visualized and Explained

Even if no headache is involved, silent migraines can be extremely disruptive to daily activities. The classic "half-moon" visual disturbance (where there is vision loss in half of both eyes), alterations in color perception, and other vision problems are also common.

A silent migraine can last from 15 to 30 minutes, but it is usually no longer than 60 minutes. It can recur or appear as an isolated event.


As with migraine disease in general, the exact causes of a silent migraine are not fully understood. Triggers for silent migraines are the same as those for other types of headaches. They can include skipped meals, skimping on sleep, specific foods or types of light, and stress, among other things.

People over 50 are more likely to have symptoms of acephalgic migraine. They can occur in those who have previously suffered full migraine symptoms or develop out of the blue.

When they occur in older people who have had migraines before, symptoms such as nausea, vomiting, and sensitivity to light and sound tend to diminish along with the headaches.

Acephalgic migraines account for 3% of migraines in women and 1% of migraines in men, according to a 2015 study in the Journal of Medical Case Reports.


It can be especially tricky for a healthcare provider to diagnose migraines when there is no headache. In some cases, people have mistakenly been diagnosed with epilepsy, based on the neurological symptoms present in the attacks. It's also possible to misdiagnose an acephalgic migraine as a transient ischemic attack (TIA) or stroke.

Specialists say acephalgic migraine should be considered as a cause whenever there is an acute episodic neurologic disorder, regardless of whether it includes headache symptoms.


Treatment of silent migraines includes preventive treatments commonly used for typical migraines with headache such as medications to treat high blood pressure, antidepressants, and antiseizure medications.

Newer treatments to prevent migraines with and without auras, such as anti-CGRP (calcitonin gene-related peptide) medications like Zavzpret (zavegepant), and newer devices like Cefaly (a transcutaneous electrical nerve stimulation device) have not been studied in people with acephalgic migraine but may potentially be beneficial.

A Word From Verywell

It is important to consult a healthcare provider if you repeatedly experience silent migraine symptoms. Depending on the circumstances, your healthcare provider may want to run tests to rule out more serious conditions, such as a TIA or seizures. If you do receive a diagnosis of silent migraine, it may be helpful to examine whether any of the traditional migraine triggers bring on the symptoms.

Frequently Asked Questions

  • Which types of food trigger a migraine?

    Common types of food that may trigger a migraine include alcohol, caffeine, processed meat, organ meat, cheese, chocolate, peanuts, fruits like citrus or kiwi, and food with lots of MSG such as fast food. These trigger foods are not universal. Some people may find that they should avoid different types of food than those listed here.

  • What is TIA?

    Transient ischemic attack (TIA) is a short-term stroke that can cause dizziness, difficulty seeing and walking, trouble with balance, confusion, trouble with speech and speech recognition, and numbness or weakness on a single side of the body. The stroke itself ends after a few minutes, but its symptoms can last between one to 24 hours. Experiencing TIA should call for an immediate visit to the hospital.

  • Is migraine with aura dangerous?

    Yes, migraine with aura can be dangerous. Migraines are known to increase the risk of stroke as well as other cerebrovascular diseases, such as carotid stenosis and aneurism. Although silent migraines do not involve aura, they can be potentially hazardous if one occurs at a particular moment, such as while driving a vehicle or operating heavy machinery.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. He Y, Li Y, Nie Z. Typical aura without headache: a case report and review of the literature. J Med Case Rep. 2015;9:40. doi:10.1186/s13256-014-0510-7

  2. Starling AJ. Diagnosis and management of headache in older adults. Mayo Clin Proc. 2018;93(2):252-62. doi:10.1016/j.mayocp.2017.12.002

  3. Weatherall MW. The diagnosis and treatment of chronic migraine. Ther Adv Chronic Dis. 2015;6(3):115-23. doi:10.1177/2040622315579627

  4. MedlinePlus. Transient Ischemic Attack.

  5. Øie LR, Kurth T, Gulati S, Dodick DW. Migraine and risk of strokeJ Neurol Neurosurg Psychiatry. 2020;91(6):593-604. doi:10.1136/jnnp-2018-318254

  6. American Migraine Foundation. Understanding Migraine with Aura.

By Rosalyn Carson-DeWitt, MD
Rosalyn Carson-DeWitt, MD is a medical writer, editor, and consultant.