Migraine Aura without Headache

What is Silent Migraine? 

Silent migraine, also known as migraine aura without headache, is a subtype of migraine where individuals experience aura symptoms but do not develop the headache phase. While typical migraine attacks are characterized by severe head pain, silent migraine attacks involve neurological disturbances without subsequent headache. Some people experience both silent migraine and traditional migraine attacks with headache, while others may have only silent migraine. Approximately 5% of people with migraine experience silent migraine. 

Symptoms Silent migraine presents with aura symptoms similar to those seen in migraine with aura, including:

• Visual symptoms: Flashing lights, zigzag patterns, blind spots, or shimmering effects in vision.
• Sensory symptoms: Tingling or numbness that spreads gradually across one side of the body, face, or tongue.
• Speech and language disturbances: Difficulty finding words or forming coherent speech (aphasia).

Despite the absence of headache, these symptoms can be unsettling and disrupt daily activities.

Cortical Spreading Depression and Silent Migraine 

Silent migraine is believed to be caused by the same underlying process as migraine with aura. A key mechanism is cortical spreading depression (CSD), a slow-moving wave of changes in brain activity that spreads across the brain’s surface, temporarily altering nerve function and blood flow. This process is thought to trigger aura symptoms by disrupting normal brain signaling.

Silent Migraine vs Migraine With Aura 

The primary difference between silent migraine and migraine with aura is that silent migraine does not include the headache phase. However, both conditions have fully reversible visual, sensory and/or speech/language symptoms and are likely caused by similar mechanisms. However unlike migraine with aura, silent migraine attacks do not have motor, brainstem or retinal aura symptoms.

Silent Migraine Phases 

Silent migraine follows the same sequence of phases as other migraine types, except that the headache phase is absent:

1. Prodrome: Early warning signs such as fatigue, mood changes, or food cravings.
2. Aura: Neurological disturbances that last between 5–60 minutes.
3. (No headache phase): Unlike typical migraine, silent migraine does not include head pain.
4. Postdrome: After the aura subsides, individuals may feel drained, fatigued, or mentally foggy.

Treatment of Silent Migraine

Since silent migraines do not involve headache, treatment focuses on preventing attacks and managing aura symptoms:

• Medications:
  • Preventive medications (e.g., beta-blockers, calcium channel blockers, antidepressants, or antiepileptic drugs) may be prescribed if silent migraine attacks are frequent or disruptive.
  • Triptans and pain relievers are generally unnecessary unless the individual also experiences migraine attacks with headache.
• Lifestyle Modifications:
  • Maintaining a regular sleep schedule.
  • Identifying and avoiding migraine triggers (e.g., stress, dehydration, bright lights, certain foods).
  • Engaging in regular, moderate physical activity.
  • Staying hydrated and maintaining a balanced diet.
  • Undergo physical therapy e.g. physiotherapy, osteopathy, to decrease muscle tension and joint stiffness in the neck, jaw, shoulders, and upper back.

Silent migraine attacks can be confusing and sometimes alarming due to their neurological symptoms. However, understanding their nature and seeking appropriate medical guidance can help individuals manage and reduce their frequency. If you experience recurrent aura symptoms, consult a healthcare provider for an accurate diagnosis and tailored treatment plan.

Typical aura without headache, despite a lack of head pain, can still be disabling for those who live with it. The more serious migraine subtypes – brainstem, hemiplegic, vestibular, abdominal, and retinal migraine – can also occur without a headache.

Managing typical aura without headache can be difficult, as there aren’t really any treatments for aura. Many medications like triptans usually take longer to work than aura’s duration, so most people don’t take any as-needed medication. Others, however, may find that associated symptoms like nausea and sensitivity to light and sound will improve if treated. 

Some small studies and case reports suggest the use of magnesium and aspirin, or for people with prolonged aura, there have been some treatment attempts with intranasal ketamine. These, however, are very small studies, and this is very much an off-label use. There are few specific studies looking at CGRP and aura, but anecdotally many have found the CGRP preventatives prevent the entire attack, including aura, so may be a worthwhile consideration.

Read more about migraine aura without the headache from the American Migraine Foundation