Migraine without Aura

What is Migraine Without Aura? 

Migraine without aura is the most common type of migraine, accounting for 70%–80% of all migraine cases. It is characterized by recurrent headache attacks that occur without the warning sign of an aura such as visual disturbances or sensory changes. This type of migraine can cause moderate to severe pain and significantly impact daily life.

Symptoms 

The hallmark symptom of migraine without aura is a headache that typically lasts between 4 to 72 hours (or 2 to 72 hours in children and adolescents) when untreated or unsuccessfully treated. The pain can present in various ways but commonly includes:

• Location: Often unilateral (one-sided), though it can be bilateral (both sides), and pain may shift sides during and/or between attacks. Younger individuals are found to experience bilateral pain more commonly than adults. 
• Quality: Pulsating or throbbing in nature.
• Intensity: Moderate to severe, making routine activities difficult.
• Aggravation: Worsens with or causes avoidance of physical activity (e.g., walking, climbing stairs).

Additional symptoms that frequently accompany the headache, and are a key feature that help distinguish between a migraine attack and other headache disorders such as tension-type headaches include:

• Nausea and/or vomiting.
• Sensitivity to light (photophobia) and sound (phonophobia).

Migraine Without Aura vs Migraine With Aura

A migraine aura is a set of neurological symptoms that occur before or during a migraine attack. These symptoms can include visual disturbances (such as flashing lights or blind spots), sensory changes (such as tingling or numbness), and difficulty speaking.

Migraine without aura and migraine with aura share many similarities, including headache characteristics, associated symptoms, and response to treatments. However, the key difference is the presence of aura symptoms in migraine with aura, which can act as a warning sign before the headache phase begins. Despite this difference, both types of migraine can be debilitating and require similar management approaches.

Migraine Phases 

Although migraine without aura does not have the aura phase which can be a warning sign of the approaching headache phase, it still progresses through distinct phases:

1. Prodrome Phase: Occurs hours or even days before the headache and may include mood changes, food cravings, fatigue, neck stiffness, or increased yawning.
2. Aura Phase: Not present in migraine without aura attacks. 
3. Headache Phase: The main attack phase, characterized by the headache and accompanying symptoms.
4. Postdrome: After the headache subsides, individuals may experience fatigue, difficulty concentrating, or a "hangover" feeling that can last up to 24 hours.

Treatment of Migraine Without Aura 

Managing migraine without aura often requires a combination of medication and lifestyle changes. Treatment options include:

• Medications:
  • Acute medications: 
    • Over-the-counter pain relievers such as ibuprofen e.g. nurofen, aspirin, or acetaminophen e.g. panadol.
    • Triptans, which are prescription medications specifically designed to relieve acute migraine symptoms.
    • Nausea medications e.g. stemetil, ondansetron. 
  • Preventative medications such as: 
    • Beta blockers.
    • Antidepressants.
    • Anti-epileptic medications.
    • Calcium channel blockers.
  • Injections:
    • Botox.
    • CGRP antibodies e.g. Emgality, Ajovy. 
• Lifestyle Modifications:
  • Applying ice packs to the head or neck to help reduce pain and inflammation.
  • Decreasing sensory stimulation during an attack by resting in a dark, quiet room, reducing exposure to screens, and minimizing loud noises.
  • Maintaining a regular sleep schedule and managing stress.
  • Identifying and avoiding common migraine triggers such as certain foods, dehydration, or excessive caffeine intake.
  • Engaging in regular physical activity while avoiding overexertion.
  • Undergo physical therapy e.g. physiotherapy, osteopathy, to decrease muscle tension and joint stiffness in the neck, jaw, shoulders, and upper back.
  • Staying well-hydrated and ensuring balanced nutrition.

There are many things that can be done to help treat and manage migraine, and understanding migraine without aura can help individuals seek appropriate treatment and lifestyle adjustments to better manage their condition. If you experience migraine attacks, consult a healthcare provider for evaluation and management options.