What Is a Migraine Without Aura?

You may be surprised to know that migraines without auras are the most common type of migraine. Additionally, migraines without auras occur more frequently and are usually more disabling than migraines with aura.

According to the third edition of the International Classification of Headache Disorders, an individual must have at least five attacks meeting the following criteria:

• Headache attacks last four to 72 hours
• Headache has at least two of the following characteristics:
  • Pain is unilateral (one-sided)
  • Pain is a throbbing sensation -- rapid beating or pulsation
  • Pain is of moderate to severe intensity
  • Migraine pain is worsened by regular physical activity (i.e., walking, climbing stairs)
• During the attack, people experience at least one of the following:
  • Nausea and/or vomiting
  • Photophobia and Phonophobia
• Headache cannot be attributed to another disorder

While the diagnosis of a migraine without aura technically involves meeting several criteria defined by the International Headache Society, your doctor may utilize the POUND mnemonic and ID migraine questionnaire—these are faster, simpler tests that can help clinch the diagnosis more efficiently.

Chronic migraines occur on 15 days per month or more.

Scientists used to believe that migraines were caused by dilatation of blood vessels in the brain. Now, they believe that nerves within the brain and spinal cord play a vital role, releasing molecules like nitric oxide and calcitonin gene-related peptide (CGRP), which trigger migraine pain. As the migraine attacks progress, the brainstem and spinal cord become sensitized. This leads to a vicious cycle of head pain and an increased sensitivity to one's environment.

Typical migraine preventive medications include:

• Antihypertensives (blood pressure lowering agents): metoprolol, propranolol, timolol
• Antidepressants: amitriptyline (Elavil) and venlafaxine (Effexor)
• Anticonvulsants: valproate products, divalproex sodium and sodium valproate, topiramate (Topamax)
• Petasites (Butterbur)

Typical treatments for an acute migraine include:

• Non-steroidal anti-inflammatories (NSAIDs): ibuprofen or naproxen sodium (Aleve)
• Triptans: Sumatriptan (Imitrex)
• Anti-nausea medications: intravenous (IV) metoclopramide (Reglan)
• Dihydroergotamines: (D.H.E. 45, Migranal)
• Dexamethasone
• Intranasal Lidocaine

• People who suffer from migraines without auras are more likely than those who suffer from other headache disorders to develop a medication-overuse headache.
• Migraines without auras commonly have a relationship to a woman's menstrual cycle.  According to the American Headache Society, 35 to 51 percent of females with migraines have menstrually related migraines.

Migraine without aura is a complicated and debilitating neurological disorder. If you think you suffer from migraines, please be sure to see a doctor for a proper diagnosis and treatment plan. Remain steadfast in your persistent quest to remain headache free.