An Overview of Silent Migraines

Also Known as Acephalgic Migraine

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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.

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.

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's usually no longer than 60 minutes. It can occur as a single, isolated event, or may recur. Even though no headache is involved, silent migraines can be extremely disruptive to daily activities.


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 for those that include headaches. They can include skipped meals, skimping on sleep, specific foods or types of light, and stress, among other things.

People over the age of 50 are more likely to have symptoms of acephalgic migraine. They can occur in those who have previously suffered full migraine symptoms, headache and all, or they can 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.

Around 3 percent to 5 percent of people with migraines can experience acephalgic migraines.


It can be especially tricky for a doctor to diagnose migraine 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 TIA or stroke.

Specialists in this type of migraine say acephalgic migraine should be considered as a possible cause whenever there's 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 as well as new devices such as Cefaly have not been studied in patients with acephalgic migraines, but potentially can be beneficial.

A Word From Verywell

It is important to consult a physician if you repeatedly experience silent migraine symptoms. Depending on the circumstances, your doctor may want to run tests to rule out more serious conditions, such as a transient ischemic attack (so-called mini-stroke) 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.

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