A silent migraine—also known as migraine aura without headache, acephalgic migraine, or typical aura without headache—is a type of migraine that presents with many of the neurological and sensory symptoms typical of a migraine, but without the hallmark head pain.
What Happens During a Silent Migraine?
Instead of a throbbing headache, people with silent migraines experience aura symptoms. These are temporary neurological disturbances that can affect vision, sensation, speech, and sometimes movement.
The most common symptoms include:
- Visual disturbances: flashing lights, zigzag or wavy lines, blind spots, blurred vision, or tunnel vision.
- Sensory changes: numbness or tingling (often starting in the hands and moving up the arm to the face), dizziness, or a pins-and-needles feeling.
- Speech and language difficulties: trouble speaking, slurred or garbled words, or difficulty finding words.
Other symptoms: nausea, vomiting, sensitivity to light or sound, confusion, and sometimes a desire to lie down.
These symptoms usually develop gradually over 5 to 60 minutes and typically resolve within an hour. However, in a significant minority of cases, certain aura symptoms can last longer than an hour:
- Visual aura: lasts more than one hour in about 6–10% of patients.1, 2
- Sensory aura: lasts more than one hour in about 14–27% of patients.1, 2
- Aphasic (speech-related) aura: lasts more than one hour in about 17–60% of patients.1, 2
Motor aura symptoms (such as weakness) can last longer than typical aura symptoms, sometimes up to 72 hours.3
How Does Silent Migraine Differ from Ocular/Retinol Migraine and Visual Migraine?
Ocular or retinol migraine is characterized by temporary visual disturbances or vision loss in one eye, sometimes occurring without headache. This is rare and may overlap with silent migraine if there is no pain, but it is usually considered a distinct entity due to its specific symptoms and risks.
Visual Migraine is often grouped with silent migraine when no significant pain is present, or only mild discomfort is experienced.
What is the difference: Ocular or retinal migraines happen in the eye, so only affect the vision in that eye, while visual migraines occur in the brain, so affect the vision in both eyes together.
Who Gets Silent Migraines?
Silent migraines are relatively rare, affecting about 4–5% of people who experience migraines. They can occur at any age but are more common in people who have a history of regular migraines. Women are slightly more likely to experience them than men.
What Causes Silent Migraines?
The exact cause is not fully understood, but silent migraines are believed to share the same underlying mechanisms as classic migraines. Triggers can include:
- Stress
- Hormonal changes (e.g., menstruation, menopause, pregnancy)
- Certain foods or drinks (caffeine, alcohol)
- Lack of sleep or changes in sleep patterns
- Bright or flickering lights
- Weather changes
- Skipped meals.
How Are Silent Migraines Diagnosed?
Diagnosis is largely clinical, based on the description of symptoms and ruling out other conditions that can mimic aura, such as stroke, transient ischemic attack (TIA), or epilepsy. Because the symptoms can resemble more serious neurological events, it’s important to seek medical advice, especially if the symptoms are new, unusually severe, or do not resolve within an hour.
Treatment and Management
Treatment for silent migraines is similar to that for other types of migraines:
- Avoid known triggers by keeping a migraine diary and tracking your episodes and any related or suspected causes.
- Medications may be prescribed to prevent attacks or reduce symptom severity, including certain anti-seizure drugs, beta-blockers, or calcium channel blockers.
- Lifestyle modifications such as regular sleep, stress management, and hydration can help reduce frequency and severity.
- Acute treatments (like triptans) are less often used since there is no headache phase, but may be considered if other symptoms are severe.
- Nutritional support from dietary supplements can be effective
When to Seek Medical Help
Some aura symptoms can be similar to those of a stroke or other serious conditions. Seek immediate medical attention if you experience:
- Sudden weakness or numbness on one side of the body
- Sudden loss of vision
- Difficulty speaking or understanding speech
- A sudden, severe headache unlike any experienced before
Key Takeaway
A silent migraine is a migraine attack that features the neurological symptoms of aura—such as visual or sensory changes—but without the headache pain. Even though there is no head pain, the symptoms can be disruptive and sometimes alarming. Proper diagnosis and management can help reduce the impact on daily life
