Silent migraine: What to know

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Most types of migraine involve pain and particularly headache. Silent migraine does not cause pain, but it shares other symptoms that typically occur with migraine. As with other types of migraine, the symptoms will depend on the stage or phase of an episode.

The prodrome phase

The prodrome phase is the earliest stage and may begin a few days or hours before severe symptoms appear.

A person may experience:

• depression
• difficulty concentrating
• difficulty speaking and reading
• fatigue and yawning
• food cravings
• irritability
• muscle stiffness
• nausea
• sensitivity to light and sound
• sleep disturbances
• frequent urge to urinate

Most people experience the prodrome phase, but it may not occur before every migraine episode.

The aura phase

Aura occurs in about 25% of people who experience migraine of any type.

However, around 4% of people with migraine have aura without headache, according to the American Migraine Foundation. In addition, nearly 40% of people who have previously experienced migraine with aura will have aura without headache later in their life.

Aura symptoms include:

• visual disturbances, such as the appearance of flashing lights in front of the eyes
• numbness and tingling in parts of the body
• temporary loss of sight
• difficulty with speech and language
• dizziness or balance problems
• loss of consciousness, in some cases

The visual changes can occur in many ways, such as:

• bright lights
• blurring
• zigzag lines
• one or more blind or black areas or complete loss of vision
• bright, white or colored dots or stars
• lines
• tunnel vision
• stationary objects that appear to move
• objects appearing larger or smaller than they really are

Migraine aura without headache will build up over time. It tends to change in the first 5 minutes of starting and can last up to an hour.

The headache phase

During the headache phase, people typically experience pain that can last 4–72 hours. This is not the case for those with a silent migraine, who are more likely to experience the following symptoms:

• anxiety or depressed mood
• giddiness
• inability to sleep
• nasal congestion
• nausea
• neck pain and stiffness
• sensitivity to light, smell, and sound
• vomiting

The postdrome phase

Approximately 80% of people who have migraine will experience a postdrome phase. It occurs at the end of the headache phase, which is why some people call it the “migraine hangover.”

The postdrome can last for 24–48 hours and may cause the following symptoms:

• body aches
• difficulty concentrating
• dizziness
• euphoria or depression
• fatigue

The exact cause of migraine is unknown, but genetic and environmental factors are likely to play a role.

Migraine may occur due to abnormal brain activity that affects nerves and blood vessels. Changes in brain chemicals, such as serotonin, may be a contributing factor.

Various factors may trigger an episode, including:

• stress
• hormonal factors
• missing meals
• weather changes
• exposure to certain types of light
• alcohol consumption

The following factors increase the risk of silent and other types of migraine:

• Sex: Migraine is more common in females than in males, primarily due to hormonal fluctuations. Migraine epidodes are more likely to occur during pregnancy and around menstruation and menopause.
• Age: The chance of experiencing migraine increases during puberty and continues to rise until the age of 35–39 years.
• History of migraine: Around 38% of people who have migraine with aura may experience aura-only migraine later in life.
• Family history: People with one parent who experiences migraine have a 40% chance of having this condition, compared with other people. If both parents have them, the risk is 75%.

A doctor can diagnose silent migraines based on a person’s symptoms and medical history. They may also do a physical and neurological examination.

A doctor may order additional tests to rule out other conditions, such as:

• blood tests
• imaging tests, including CT scans and MRI scans
• a spinal tap or lumbar puncture
• dilated eye exam

It is vital to seek medical attention when experiencing aura symptoms for the first time because they can mimic symptoms of other conditions, such as stroke and meningitis.

Specific treatment options for silent migraine are limited, and more research is needed to establish an approach. However, strategies for managing migraine with headache may help.

Typical migraine medication — such as oral triptans or NSAIDs — may not work quickly enough to treat aura, but they may help manage other symptoms, such as nausea and dizziness.

People who have severe or frequent episodes may benefit from regular medications, such as calcium channel blockers, to manage the condition and prevent episodes.

Lifestyle changes that may help reduce or prevent aura or migraine symptoms include:

• identifying and avoiding triggers where possible
• managing stress
• getting enough sleep and rest

Anyone with severe symptoms may benefit from preventive medication that a doctor can prescribe.

According to the American Migraine Foundation, silent migraine that occurs twice a year or less can be troublesome, but its impact tends to be less severe than that of migraine with headache.

However, silent migraine can impact a person’s daily functioning, for instance, if visual aura symptoms affect their ability to drive.

Some people may have severe symptoms that occur frequently and last several days. These people may need ongoing medical treatment to lower the risk of an episode.

Anyone with symptoms of aura or migraine should see a doctor. They will help identify the cause, rule out other conditions, and advise on treatment options.

Here are some questions people often ask about silent migraine.

What do silent migraines feel like?

Silent migraine involves an aura, which often involves visual disturbances, such as flashing lights. It can also cause nausea, dizziness, and other symptoms that typically occur with migraine, but it does not involve a headache.

How do you fix or get rid of a silent migraine?

Treatment options for migraine aura without headache are limited, but some migraine medications may help manage the condition. A doctor will approach silent migraine on a case-by-case basis.

Can anxiety cause a silent migraine?

Some 80% of people with migraine say that stress can trigger an episode. Similar triggers are likely to cause a silent migraine episode.

What triggers a silent migraine?

The same triggers that can cause other type of migraine attack can trigger silent migraine. They include stress, hormonal factors, and light exposure.

Migraine aura without headache — sometimes called silent migraine — involves the same symptoms as a typical migraine, but without headache. The aura can last up to an hour and may feature flashing lights, dizziness, and other sensory changes.

Silent migraine affects around 4% of people with migraine. For some, it is more of a nuisance while for others it can affect their ability to function in daily life.

It is essential to seek medical advice if a person has any migraine or aura symptoms. A doctor may wish to rule out other possible causes and can offer treatment to help manage the condition.