When Migraine Strikes Without the Pain

Olivia Orr
48 minutes ago
3 min read

Olivia Orr, RN, BSN

Migraine without a headache. How is that possible? Isn’t a migraine just a bad headache? Not at all. Migraine aura without headache (MAWH) is the medical term for this condition. This form of migraine comes without head pain, earning it the nickname of silent migraine.

What is Silent Migraine?

The American Migraine Foundation (AMF) defines migraine aura without headache as a migraine aura that lacks the accompanying headache. Migraine is often misunderstood as just a bad headache, but head pain is only one symptom. Migraine is a broad neurological condition with symptoms such as nausea, vomiting, mood changes, fatigue, confusion, brain fog, sensory sensitivity, and aura. Aura can cause a mix of visual, sensory, and sound disturbances. Migraine with aura can change into silent migraine; very few people begin with silent migraine. The AMF states that two distinguishing marks of silent migraine are: both eyes are affected, and the aura can change and build over 5-60 minutes.

Aura symptoms may include:

Blind spots, flashing lights, or zigzag lines
Numbness
Tingling
Slurring
Word-finding problems
Confusion

People often experience fatigue and brain fog after an episode. Symptoms are fully reversible and do not cause long-term damage.

Impact on Daily Life

The best way to prevent a silent migraine attack is to track possible triggers. A trigger is anything that causes a migraine attack. Triggers vary widely, so identifying each one will take time. Every time you experience a migraine, write down the date, time, weather, meals, activity, and the amount of sleep you had in the last 24 hours. Review this log periodically to identify patterns.

Common triggers are:

Stress
Sleep disturbances
Bright lights, loud sounds, strong scents
Weather changes
Hormonal changes
Dehydration
Foods: caffeine, MSG, alcohol
Skipped meals/low blood sugar

Silent migraine can affect a person for hours to days before and after an attack. The prodrome phase, which occurs before an attack, may cause mood swings, food cravings, increased urination, irritability, sensitivity to light and sound, nausea, hyperactivity, and yawning. The postdrome phase, after an attack, can cause fatigue, poor concentration, and confusion. These invisible symptoms make it difficult to function normally and effectively, causing unproductive days. The anticipation of an unexpected attack can lead to anxiety and sometimes isolation. Understanding your type of migraine and knowing your triggers can give you a sense of control over an unexpected attack. Learn about yourself, be your own advocate, and join a migraine support group; knowledge will empower you to live your best life.

When to Seek Medical Care

If you experience these symptoms for the first time, if your symptoms change, or if they are prolonged, please seek medical attention. Do not assume what you are experiencing is silent migraine. The AMF estimates that 4% of people with migraine disease experience silent migraine, and almost half of these people experienced migraine with aura first. Silent migraine is uncommon, making medical evaluation vital. Symptoms can resemble stroke, trans-ischemic attack (TIA), anxiety, seizures, and other diseases, requiring patients to undergo medical tests such as a neurological exam, magnetic resonance imaging (MRI), and blood work. A neurologist is trained to rule out other possibilities and diagnose migraine aura without headache.

Migraine aura without headache, or silent migraine, is a disruptive, chronic condition that is largely unheard of. Awareness is the first step in managing it. If you suspect silent migraine, speak with your health care provider about how to manage it, lifestyle changes you can make, and possible medications to prevent attacks.

Sources

Assessed and Endorsed by the MedReport Medical Review Board