An Overview of Migraine Without Aura

Migraine without aura is one of two major types of migraines, and 75% of those who have the condition experience this particular kind. Also known as "common" migraine, people who have migraine without aura don’t get the visual or sensory warning signs, known as migraine prodrome, that are classic to the other type—migraine with aura.

Symptoms

The symptoms you experience during migraine without aura may not be exactly the same as someone else. Likewise, they can differ from episode to episode.

Symptoms of migraine without aura include:

• Pain on one side of head
• Pulsing or throbbing pain
• Sensitivity to light (photophobia)
• Sensitivity to sound (phonophobia)
• Nausea and/or vomiting
• Pain or discomfort that is made worse by physical activity

Causes

Scientists used to believe that migraines were caused by dilation of blood vessels in the brain. Now they believe that the release of substances, such as calcitonin gene-related peptide (CGRP), from activated trigeminal nerves will trigger the migraine pain.

Migraines are also associated with estrogen, which explains why migraines are more prevalent in women. Typically, higher estrogen levels will prevent migraine headaches, whereas lower estrogen levels can trigger them. But it may be more the fluctuation or change in estrogen that triggers a migraine, not simply the fact that the level is low.

Estrogen is also associated with increased levels of serotonin in the brain, so a decline in estrogen may be accompanied by a decrease in serotonin. Researchers believe that fluctuations in serotonin levels play a role in triggering migraines.

According to the American Migraine Foundation, migraine disease is often hereditary; if one or both of your parents have it, you have a 50% to 75% chance of getting it too.

Diagnosis

The diagnosis of migraine without aura is based on symptoms and history that you report to your healthcare provider.

According to the third edition of the International Classification of Headache Disorders, a diagnosis of migraine without aura can only be made when a person has at least five attacks meeting the following criteria:

• Headaches that last four to 72 hours
• Headaches that have at least two of the following characteristics: Unilateral (one-sided); a throbbing sensation, such as rapid beating or pulsation; pain that is of moderate to severe intensity
• Migraine pain worsened by regular physical activity (i.e., walking, climbing stairs)
• Nausea and/or vomiting
• Photophobia and phonophobia
• Headache that cannot be attributed to another disorder

Your healthcare provider may also have you answer the POUND mnemonic and ID migraine questionnaire, which can help clinch the diagnosis.

There is no blood test or imaging test that can confirm the diagnosis, although these may be used to rule out other possible causes, such as a tumor, stroke, brain bleed, and other neurological conditions.

Treatments

Medications

Historically, migraine treatment was limited to medications that were approved for other uses but were found to be beneficial for helping migraine symptoms. Within the last few years, however, the Food and Drug Administration (FDA) has approved a newer class of medications that are specifically approved for the treatment of migraine.

CGRP inhibitors help prevent or treat acute migraine by blocking CGRP from attaching to receptors in the brain. Options in this class, broken down by use, include:

• Migraine prevention: Vyepti (eptinezumab-jjmr), Emgality (galcanezumab-gnlm), Aimovig (erenumab-aooe), Ajovy (fremanezumab-vfrm), Nurtec ODT (rimegepant)
• Acute migraine: Ubrelvy (ubrogepant), Nurtec ODT (rimegepant), Zavzpret (zavegepant)

Numerous other types of medications can be used to prevent migraines or treat them once they've taken hold.

Medication classes shown to help treat acute migraine include:

• Non-steroidal anti-inflammatories (NSAIDs), such as (Advil) ibuprofen or (Aleve) naproxen sodium
• Triptans, including Imitrex (sumatriptan) and Zomig (zolmitriptan)
• Antiemetics (anti-nausea medications)
• Dihydroergotamines, including Migranal (D.H.E.)
• Dexamethasone
• Nerve blocks

Medication classes shown to help prevent migraine include:

• Antihypertensives (blood pressure lowering agents), such as metoprolol, propranolol, and timolol
• Antidepressants, such as Elavil (amitriptyline) and Effexor (venlafaxine)
• Anticonvulsants: These include valproate products, divalproex sodium, sodium valproate, and Topamax (topiramate)
• Botox (onabotulinumtoxin A), an injectable muscle paralytic drug used for chronic migraine prevention

People who suffer from migraines without aura are more likely than those who have other headache disorders to develop a medication-overuse (rebound) headache. Be sure to take a migraine drug exactly as directed.

Non-Medication Options

Beyond medications, there are also several neuromodulation devices that have been approved by the FDA for treatment of migraine without aura. These include:

• Transcutaneous supraorbital neurostimulator (tSNS): Also called the Cefaly device, it uses electricity to activate forehead nerves. The signal goes into the brain, slowly turning down headache pathways over time.
• Single-pulse transcranial magnetic stimulator (springTMS, sTMS): This magnet is placed on the back of the head and turned on for a split-second pulse.
• Non-invasive vagal nerve stimulator (nVNS): Called gammaCore, this device is placed on the neck over a gel and turned on to electrically stimulate the vagus nerve.
• Remote electrical neuromodulation (REN): REN stimulates small nerves in the upper arm. The message from the arm is received by a brainstem pain regulation center that can inhibit pain signals by releasing neurotransmitters, resulting in significant pain relief which can end the migraine attack. Currently, the only REN device approved for use by the FDA is Nerivio, which is secured to the arm using an armband.

Alternative treatments—including acupuncture, massage, and certain herbs and supplements—may also be helpful for preventing and treating migraines. Furthermore, many find lifestyle measures, such as meditation, exercising, avoiding certain foods, and getting enough sleep, to be an important part of their overall care.

Coping

Migraine without aura can be disabling, causing you to miss work and social events, and making it difficult to care for your loved ones. Because migraines are so prevalent, numerous online and in-person support groups are available for patients as well as their families and caregivers. Your healthcare practitioner can help you find support groups.

A Word From Verywell

Migraine without aura can be a debilitating neurological disorder, but fortunately, a variety of treatments are currently available that people who suffer from this condition can try. If you think you suffer from migraines, make sure to see a healthcare provider for a proper diagnosis and treatment plan.