An Overview of Silent Migraines

A.K.A. Acephalgic Migraine

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Acephalgic migraine, or "silent migraine," is a form of migraine that occurs without an actual headache. Any type of migraine—whether or not it's accompanied by an aura—can be a silent migraine.

Symptoms

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 one eye, alterations in color perception, and other vision problems and are also common.

A silent migraine can last from seconds to hours. It can occur as a single, isolated event, or may recur as often as several times a day. Even though no headache is involved, silent migraines can be extremely disruptive to daily activities.

Causes

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, whereas autonomic symptoms and neck pain tend to increase.

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

Diagnosis

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 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

Treatments are the same for silent migraines as for typical migraines with headache. A variety of medications, both prescription and over-the-counter, are available. Among them are anti-inflammatory drugs (such as ibuprofen or aspirin), high blood pressure medicines (such as beta-blockers or calcium channel blockers), triptans, ergot alkaloids, and anti-CGRP (calcitonin gene-related peptide) medications.

Newer treatments include devices (such as the Cefaly) that use external electrical stimulation to prevent or treat migraines. There is some evidence that disruption of electrical activity in the brain may be an early event in a migraine. The idea behind these devices is that they may alleviate altered electrical activity, preventing or reducing the symptoms of a migraine.

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 (a 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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