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What is a silent migraine? It doesn’t have anything to do with sound. In fact, silent migraines don’t involve a headache. When you think of migraine symptoms, you probably think of severe headache pain, accompanied by neurological symptoms, such as visual disturbances, dizziness, nausea, or weakness. These neurological symptoms are called auras, and they usually last 20 minutes to an hour.
People with typical migraines experience an aura phase as a “warning sign” before their headache pain begins. They may also experience aura symptoms during their headaches.
However, people with silent migraines have auras without the accompanying migraine head pain. As a MyMigraineTeam member writes, “Something new happened today. I had all the symptoms of a migraine — nausea, light and sound sensitivity, and chills. But I didn’t have migraine pain.”
Even without a headache, these aura experiences are still migraines. Silent migraines are also called acephalgic (or amigrainous) migraines or “typical aura without headache.” They can also be called ocular migraines if they affect the eyes.
Only about 10 percent to 30 percent of people with migraines experience silent migraines. Although silent migraines are less common, they still can have devastating effects on your quality of life. Aura symptoms can be frightening, and they can also make daily tasks, such as reading a computer screen or driving, difficult or even impossible. As a MyMigraineTeam member reported, “I can be at work happy as anything. Then the next minute, I get a blind spot — my hand starts going numb. Then I have to shoot off home straightaway.”
The visual symptoms of an aura include blind spots or temporary blindness, flashing lights, and seeing sparkles, zigzag lines, or colored spots. One MyMigraineTeam member wrote that her migraine symptoms appeared as “red lights flashing all around my room ... the red flashing continued for a few minutes. Sometimes, it looks more like moving grayish flying shadows.” Another wrote, “My vision goes to nearly black with purple and green glowing lights that bubble back and forth like a '70s-era lava lamp.”
Other neurological symptoms include dizziness, numbness, tingling, and a feeling of weakness on one side of the body. A MyMigraineTeam member described “a physical aura where the outside of my right calf starts aching. Some might describe it as numbness, but I think it’s pain.”
These symptoms can be severe. “Last week, I went to the emergency room because the left side of my body became weak and numb. I had a very hard time forming sentences or speaking much at all,” a MyMigraineTeam member said. “I did not have a stroke, which is what I thought was going on. This morning, the same weakness started again. My face all the way down to my leg feels numb and weak.”
As this MyMigraineTeam member shared, these silent migraine attacks can be difficult to distinguish from a stroke — especially a type of stroke called a transient ischemic attack (TIA). TIAs, or ministrokes, occur when the blood vessels to the brain, spinal cord, or parts of the eyes are blocked for a very short period of time. TIAs cause symptoms similar to those of a silent migraine, such as muscle weakness on one side of the body, dizziness, and vision difficulties.
How can you tell the difference between a silent migraine and a TIA? It can be difficult, but migraine aura symptoms tend to develop slowly and intensify over time, and TIA symptoms appear all at once.
Researchers believe that migraine auras are caused by disruptions in electrical activity, called cortical spreading depression. These disruptions occur in the cerebral cortex, a part of the brain that controls your senses and motor functions.
Migraine auras can be triggered by several factors. These include:
Silent migraines can be difficult to treat because many migraine medications, such as over-the-counter painkillers or oral triptans, are meant to treat headaches, not aura symptoms. In addition, these medications are relatively slow-acting drugs, and aura symptoms last for less than an hour. By the time these medications kick in, the aura symptoms are already over.
There are no treatments approved by the U.S. Food and Drug Administration (FDA) specifically targeting the symptoms of silent migraines after they start. A few small studies have found that magnesium and aspirin are useful in treating migraine aura, as well as the anticonvulsant drug Lamictal (lamotrigine).
Some MyMigraineTeam members report success combating auras with magnesium and aspirin. “It may sound strange, but my neurologist put me on magnesium and [vitamin] B2 to take at bedtime,” a member stated. “The magnesium does something. I get auras and took it and the aura let up.” According to another member, “A neurologist I saw advised me to chew an aspirin when the visual aura started and it would stop the aura. I tried it and it worked for me.”
Several preventive medications can help stop aura symptoms from developing in the first place. These medications include antidepressants, antiseizure drugs, and Botox injections. Several types of antidepressants can be prescribed to prevent aura, including Effexor (venlafaxine), Prozac (fluoxetine), and Zoloft (sertraline). Anticonvulsants include Topamax (topiramate), Neurontin (gabapentin), and Depacon (valproate sodium).
“I take an antidepressant at present, which has helped, as I was getting auras daily,” one MyMigraineTeam member said. “Now summer has come and I’ve felt them trying to break through, but I haven’t had one for 10 months (fingers crossed), even though they’ve always been worse in the summer with the sun.”
Another member reported a good experience with an anticonvulsant. “My migraine is called chronic silent migraine, a migraine without the pain. I am taking topiramate at bedtime, and it is working well so far.”
Preventive medications also include drugs that lower your blood pressure, such as beta-blockers and calcium channel blockers. Common beta-blockers include propranolol (sold under the brand names Inderal and InnoPran XL) and Lopressor (metoprolol). Calcium channel blockers include verapamil (sold under the brand names Calan, Covera-HS, and Verelan).
Some members feel that blood pressure drugs have positive effects in treating aura. “I was getting migraine auras daily, then I was put on propranolol. Not had a migraine for over a week now,” one MyMigraineTeam member said.
On MyMigraineTeam, the social network and online support group for those living with migraine headaches, members talk about a range of personal experiences, including silent migraines.
Do you have silent migraines? Do you have tips on preventing silent migraines or treating them when they happen? Comment below or post your migraine tips and experiences at MyMigraineTeam. You’ll be surprised to learn how many others share similar stories.
Amit M. Shelat, D.O. is a fellow of the American Academy of Neurology and the American College of Physicians. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jessica Wolpert works to empower patients through the creation of content that illuminates treatments' effects on the everyday lives of people with chronic conditions. Learn more about her here.
