What Are Silent Migraines?

It seems odd to call a silent migraine a "headache." What makes this neurological disorder different from the migraines most people think of is that you don't get the usual pain. Even without it though, the other symptoms can be unsettling and can disrupt your normal day.

Your doctor can prescribe medications and devices to prevent silent migraines and treat their symptoms. Taking good care of yourself and avoiding your triggers will help, too.

Symptoms

A silent, or acephalgic, migraine can have symptoms of any phase of a migraine -- but without the classic pain around your temples.

During the prodrome, the phase that warns you a migraine is coming, you could:

  • Get "hyper" or cranky
  • Have food cravings
  • Be fatigued and yawn more
  • Feel stiff, especially your neck
  • Need to pee more often
  • Get constipated or have diarrhea

The aura phase usually lasts about an hour. It's best known for its unusual visual symptoms, such as seeing:

  • Wavy or jagged lines
  • Flashing lights
  • Dots or spots in your vision
  • Blind spots
  • Tunnel vision

But it can also affect your other senses, movement, and speech.

  • Trouble hearing, or hearing things that aren't there
  • Strange smells or tastes
  • Numbness, tingling, or a pins-and-needles feeling
  • Weakness
  • Difficulty remembering or saying a word

Even though your head doesn't hurt, this headache may affect your body in other ways.

Afterward, many people are wiped out and have the blahs for as long as a day.

Not all migraines follow the same pattern. Even for the same person, migraines can be unpredictable.

Pain and Aura Causes

Researchers are now looking at the aura and the pain as two distinct things.

In the past, experts thought migraines were mainly a problem with blood flow in your brain: Blood vessels in the brain expand, and the swelling activates pain pathways in the nervous system. Now they believe the headaches involve the way nerve cells are firing in your brain and how that activity relates to the blood flow.

Continued

Aura appears to be a case of overstimulation of the nerve cells and then drop-off of activity in the brain. The decrease literally spreads across the top layer, or cortex, of your brain. It often travels from the visual part of the brain (occipital lobe) to the body sensation part of the brain (parietal lobe) to the hearing part of the brain (temporal lobe). This mirrors the visual, sensation, and hearing symptoms common to migraine.

You can see this wave, called cortical spreading depression, with a functional MRI, a high-tech way of mapping how the brain works.

Triggers

Silent migraines can be set off by the same things that cause painful migraines.

What and how you eat are common triggers, including:

It could be something happening around you:

  • Bright or flickering lights
  • Loud noise
  • Weather and extreme heat or cold

Changes in hormone levels -- during menstruation, pregnancy, or menopause, or when taking birth control pills -- may affect women.

Your general well-being is also important.

  • Stress, either physical or emotional
  • Lack of sleep
  • Skipped meals

Diagnosis

Headache experts may not agree on everything, but they do agree that keeping a daily diary is a critical step. Try to track everything you eat and drink, changes in your sleep or stress levels, and other possible triggers. Also, keep track of your symptoms and the times they begin and end. Your diary and your medical history will help your doctor figure out what's going on.

In rare cases, your symptoms could be a sign of a different, more-serious medical problem, such as a stroke or bleeding in the brain. To rule these out, your doctor may want to do more tests, such as a CT scan or MRI, or have you see a specialist called a neurologist for an exam.

Treatment and Prevention

More than 100 medications can treat migraine. Be prepared to try different drugs to find the right one for you. Tell your doctor about all prescription and over-the-counter medicines you're taking to avoid problems with how any of them work and side effects.

Once you've realized what they are, try to stay away from your triggers. If your symptoms are severe or regular, your doctor may prescribe a medication or device to help prevent your migraines.

Eat well, get plenty of rest, and exercise most days. Find ways to get rid of stress when you can and manage it when you can't.

WebMD Medical Reference Reviewed by Neil Lava, MD on July 14, 2016

Sources

SOURCES:

National Headache Foundation: "Headache - Frequently Asked Questions."

National Library of Medicine: "Migraine with Aura."

Migraine Research Foundation: "About Migraine."

eMedicine.com: "Pathophysiology and Treatment of Migraine and Related Headache."

National Institute of Neurological Disorders and Stroke: "21st Century Prevention and Management of Migraine Headaches."

News release, FDA.

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