Silent Migraine: Causes, Symptoms, Treatment

Most people associate a migraine with a severe headache.

But it is possible to have a migraine attack with no head pain.

This is called a silent migraine, or migraine aura without headache.

The term “silent migraine” is no longer the preferred way to refer to these, as there are concerns the word “silent” diminishes the discomfort of the individuals affected by these.

Because some people are more familiar with the term “silent migraine,” I will use both terms interchangeably in this article.

But I want to acknowledge that silent migraines are anything but silent to those experiencing them.

In this article, I’ll explain the causes of and risk factors for silent migraines, their symptoms,  and some options for treatment and prevention.

I’ll also tell you when you should talk to your doctor.

What Causes Silent Migraines? 

Even without head pain, silent migraines can still be debilitating, causing nausea, vomiting, or sensory disturbances during the attack phase.

It is thought that some people who experience migraine headaches with auras can lose the headache phase as they get older—this causes the aura without headache.

Risk factors 

Anyone can get migraines.

But the risk is higher for people who:

• Have a family history of migraine
• Have a vagina
• Are between the ages of 18-44
• Are experiencing hormone changes with menstruation, pregnancy, or menopause

Triggers

Triggers of migraines can include:

• Stress or anxiety

• Menstrual cycle changes

• Foods: Aged cheese, red wine, MSG (monosodium glutamate), chocolate, dairy products, alcohol, smoked meats, artificial sweeteners. Skipping meals is actually more associated with triggering a migraine than food changes.

• Sensory stimulation: Bright lights, strong smells (like perfumes), loud noises

• Weather changes: Barometric pressure shifts, sudden temperature changes, storms, or traveling to a different location with a different altitude

• Sleep changes: Too much or too little sleep

• Caffeine: Sudden changes to usual caffeine intake

Symptoms

Typical migraines present with four phases: prodrome, aura, headache/attack, and postdrome.

Silent migraines may still have these phases.

The attack phase in typical migraine includes head pain with nausea, vomiting, or sensory disturbances.

Silent migraines can still include these other symptoms, but there is no head pain.

Prodrome phase

These pre-migraine symptoms can happen a few hours or a few days before the migraine starts.

Prodrome symptoms may include:

• Poor concentration
• Neck and muscle pain
• Fatigue
• Excessive yawning
• Light and sound sensitivity
• Mood changes
• Sugar cravings
• Constipation or diarrhea
• Frequent urination

People may have some, many, or none of these leading up to a migraine attack.

Aura phase

Aura refers to sensory symptoms that may happen before or during a migraine.

Around 25% of people who get migraines have aura.

Aura symptoms can include:

• Visual disturbances or changes: Flickering lights, bright lines, blind spots, blurred vision

• Sounds: Ringing in ears, hearing sounds more softly or loudly, hearing music

• Sensory: Tingling, numbness, pins and needles

• Motor changes: Jerking, repetitive motions, muscle weakness

People who experience auras may have only one or many of these.

Headache phase

In a silent migraine, there is not a typical onset of head pain.

Instead, other symptoms associated with migraine can occur, including:

• Nausea and vomiting
• Sleep problems
• Sensory sensitivity (light, sounds, smells, tastes)

Migraine attacks, even without head pain, can last from a few hours to 3 days.

Postdrome phase

Postdrome is the post-migraine stage.

In silent migraine, it is harder to distinguish when the postdrome phase starts.

In typical migraine, postdrome begins after the head pain has ended.

It may last for a few hours or a few days.

Postdrome symptoms may include:

• Fatigue
• Discomfort in the area the migraine was previously felt

Diagnosis 

If you have migraine aura without headache, it can be harder to diagnose.

Because aura symptoms without headache can be signs of other serious neurological disorders or infections, you will need a medical exam to receive a proper diagnosis.

Do not self-treat silent migraines unless you have already been diagnosed.

To diagnose silent migraine, a primary care provider, ER physician, or neurologist may order one or more of the following tests:

• Blood tests
• CT scans
• MRI
• Lumbar puncture

Treatment

Treatment for silent migraines will depend on the severity of your symptoms, and how frequently you experience migraine attacks.

If they happen infrequently, you may not need medical treatment, especially since the aura may be short-lived.

Migraines can’t be cured, but understanding what triggers them may help you prevent them or reduce the severity of symptoms.

If you are diagnosed with silent migraines and require treatment, it is the same as for other types of migraine.

Lifestyle changes

Since stress is a common migraine trigger, finding healthy ways to manage stress in your life can be effective for decreasing migraine attacks.

Some effective ways to use stress management to address migraine headaches include:

• Biofeedback
• Cognitive behavioral therapy
• Meditation
• Yoga

If you are more stressed than normal or feel a migraine coming on, there are some lifestyle adjustments that you can make that may help.

• Make sure that you are hydrated.
• Get some rest in a dark, quiet room.
• Avoid food triggers like aged cheeses, red wine, dairy, MSG, and food additives.

Home remedies

Home remedies that can help migraines are:

• Warm compresses, showers, or baths may relax muscles and decrease muscle tension or stress.

• Drinking a little caffeine, the equivalent to one cup of coffee, may help stave off an attack.

• Some supplements, including vitamin B2, magnesium, coenzyme Q10, and feverfew, may help. Don’t take supplements unless your healthcare provider has cleared them. Supplements can interact with foods, medications, or other supplements and may still cause problematic side effects for some people. This is especially true if you have liver or kidney issues.

Medications

Over-the-counter pain relievers may help with silent migraine:

• Acetaminophen (Tylenol)
• Naproxen (Aleve)
• Aspirin
• Ibuprofen (Advil, Motrin)
• Excedrin, which combines acetaminophen, aspirin, and caffeine

Prescription medications which may help prevent migraine attacks include:

• Anticonvulsants (gabapentin, levetiracetam, pregabalin)
• Antidepressants (amitriptyline, fluoxetine, paroxetine, sertraline, others)
• Beta-blockers (atenolol, metoprolol, propranolol, others)
• Botox injections
• CGRP antagonists (erenumab, fremanezumab)
• Calcium channel blockers (diltiazem, nimodipine, verapamil)

Prevention 

The best way to prevent silent migraines is to understand what triggers them for you.

Keep a journal where you note what you were doing in the hours or days before a silent migraine attack, as well as anything you may have eaten, medications you may have taken, beverages you’ve consumed, and social events you’ve attended.

Keep track of your silent migraine symptoms, how long they lasted, and anything you did to try to help resolve them.

This information can help you be more proactive in preventing silent migraine, but may also help a healthcare provider make an accurate diagnosis or order the right diagnostic testing.

After you know what tends to trigger migraines for you, you can avoid triggers and manage your lifestyle.

Some preventive lifestyle management options include:

• Dietary changes
• Avoiding certain types of social situations
• Setting healthy boundaries to manage stress
• Getting a consistent amount of sleep
• Getting regular exercise
• Staying hydrated
• Keeping a low, but consistent, caffeine intake
• Avoiding alcohol and tobacco

When to See a Medical Provider

Silent migraines occur in response to neurological changes in the brain.

Contact your doctor or a healthcare provider if you experience signs of silent migraine.

Do not try to self-diagnose silent migraines.

Seek emergency medical help if you ever have trouble speaking or develop weakness on one side of the body, or if you notice visual changes or other neurological disturbances. 

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