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What is a Silent Migraine?

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Updated February 13, 2009

(LifeWire) - When is a migraine not a headache? While this might sound like a riddle, it actually has a serious answer.  Surprisingly, migraines can occur without the classic pulsing head pain. In fact, about 3 to 5% of people with chronic migraines experience such headache-free migraines, known as "silent migraines."

Often, silent migraines occur in older adults who have previously suffered full migraine symptoms, headache and all. In other cases, adults over age 40 develop these headache-less migraines out of the blue. Silent migraines can also be referred to as:

  • Acephalgic migraine: Acephalgic is the Latin word for "without head pain"
  • Isolated visual migraine
  • Late-onset migraine accompaniment: Occurs when the condition first strikes someone over the age of 40
  • Migraine dissocié: The French name for a migraine that is dissociated from (that is, not related to) headache
  • Migraine equivalent or migraine variant
  • Typical aura without headache
To understand silent migraines, it helps to know a bit about migraines in general and how an episode tends to progress. A classic migraine moves through four phases:
  1. Prodrome (sometimes called "preheadache"): Approximately 30 to 40% of individuals who have migraines recognize warning symptoms that occur several hours or even days prior to the onset of headache. These so called prodrome symptoms can include muscle stiffness, especially in the neck, mood changes or irritability, food cravings, fatigue, constipation, diarrhea, or frequent urination.
  2. Aura: This is the term for the distinctive symptoms that some individuals have immediately before the onset of headache. The most common aura symptoms are visual, and can include flashing lights, wavy or zigzagging lines, or other changes in the visual field. Additional symptoms that may accompany aura include hallucinations involving scents or sounds, a sensation of numbness or tingling on the face or extremities, confusion or vertigo. Approximately 20% of individuals who have migraines experience such premonitory auras, though these individuals may not have an aura before every headache.
  3. Headache
  4. Postdrome (or postheadache): This is the term for symptoms that occur after headache has been relieved. It can take hours or even days to recover from a migraine headache. Many people who have migraines describe the aftermath as like a hangover. Postdrome can involve depression or a sense of euphoria, or difficulties with concentration or thinking.

Migraines come in various types and may not include all four phases.

So what sets a silent migraine apart? The lack of headache. Though silent migraines frequently include a prodrome or postdrome, they do not involve the phase that, for most individuals, defines a migraine -- the nauseating, throbbing, one-sided head pain.

A silent migraine commonly consists of visual changes that are typical of the aura phase. An individual with a silent migraine may notice visual symptoms that are termed "positive features," which may include shimmering mirages or stripes, crazy flashes or tiny glittering points of light, or patterns or colors that appear out of nowhere. Frequently, aura symptoms can also involve pins and needles sensations or numbness in the hands, feet, arms, legs or face.

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. Just because no headache is involved, individuals experiencing silent migraines are not getting off easily. The visual symptoms of a silent migraine can be extremely disruptive to daily activities, not to mention disconcerting and downright frightening.

In some cases, these visual special effects are so spectacular they can feel like hallucinations. Some literary experts contend that the author Lewis Carroll may have been a migraine sufferer who experienced a crazy, distorted world courtesy of the visual disturbances of the migraine aura, which may account for the fantastic morphing of reality described in his book Alice in Wonderland.

Should you experience new symptoms like those of a visual aura, it is important to consult a physician. Depending on the circumstances, your doctor may run several tests to rule out more serious conditions, such as a transient ischemic attack (a so-called mini-stroke) or seizures.

Despite its name, a silent migraine may not be all that silent. If the frequency of these silent episodes interferes with your daily life, it may be helpful to examine whether any of the traditional migraine triggers instigate your symptoms. Migraine triggers vary widely -- from skipped meals or skimping on sleep to unchecked stress or emotion, or even to specific foods.

If diligently avoiding your triggers does not quell the severity or frequency of your silent migraines, a variety of medications, both prescription medications and over-the-counter medications, are available. Over-the-counter anti-inflammatory drugs (such as ibuprofen or aspirin), high blood pressure medicines (such as beta-blockers or calcium channel blockers) or antidepressants, may help alleviate your symptoms.

Sources:

Cutrer, F. Michael, and Michael A. Moskowitz. Headaches and Other Head Pain. Cecil Textbook of Internal Medicine. 23rd ed. Eds. Lee Goldman and Dennis Ausiello. Philadelphia: Saunders, 2008. 2640-2642.

Freedom, Thomas and Walter M. Jay. Migraine With and Without Headache. Seminars in Ophthalmology 18.4 (2003): 210-217.
<http://www.informaworld.com/smpp/content~content=a714020224?words=migraine%7cwithout%7cheadache&hash=1168259575> (subscription)

Lim, Chun. Headache, Migraine. Ferri's Clinical Advisor 2008. First Ed. Ed. Fred Ferri. Philadelphia: Mosby Elsevier, 2008. 374-375.

McConaghy, John R. Headache in Primary Care. Primary Care: Clinics in Office Practice. 34.1 (2007): 83-97.
<http://www.primarycare.theclinics.com/article/S0095-4543(06)00070-4/fulltext>

Pryse-Phillips, William and T. Jock Murray. Headache. Textbook of Primary Care Medicine. Third ed. Ed. John Noble. St. Louis: Mosby, 2001. 1500-1507.

Silberstein, Stephen D. and William B. Young. Headache and Facial Pain. Third ed. Textbook of Clinical Neurology. Ed. Christopher G. Goetz. Philadelphia: Saunders, 2007. 1245-1253.  
LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Rosalyn Carson-DeWitt, MD, works as a medical writer, editor, and consultant in Durham, North Carolina. She served as editor-in-chief for two multi-volume MacMillan encyclopedias: "The Encyclopedia of Drugs, Alcohol, and Addictive Behavior" and "Drugs, Alcohol and Tobacco: Learning About Addictive Behavior." She worked on the 18th edition of the Merck Manual of Diagnosis and Therapy, and has written thousands of print and online articles for healthcare providers and consumers.
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