How to Recognize a Silent Migraine and 4 Ways to Feel Better

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Silent migraines can affect your vision and balance.
Image Credit: Ekaterina Goncharova/Moment/GettyImages

Let's play a little word association game: When I say "migraine," you say…? If words such as "pain," "headache" and "throbbing," come to mind, that makes sense — after all, migraines are commonly known for causing pulsating, pounding and often disabling head pain.

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But not all migraines are created equal. In fact, some don't involve ‌any‌ pounding or aching. Instead, they're characterized by symptoms such as visual, sensory or speech and language disturbances.

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

Here, learn about this type of condition, including common silent migraine symptoms and treatment options.

What Is a Silent Migraine, Exactly?

The medically accurate term for a silent migraine is a "migraine aura without headache," Laura R. Natbony, MD, FAHS, fellow of the American Headache Society and founder and medical director of Integrative Headache Medicine of New York, tells LIVESTRONG.com. "Which means there is vision, sensory, speech and/or motor changes not accompanied by head pain."

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An aura is best defined as a recurrent attack that features temporary sensory disturbances, such as seeing dots or spots, having difficulty hearing or speaking clearly and experiencing tinnitus or dizziness, according to the Cleveland Clinic.

Generally, this type of attack precedes the onset of a migraine headache, but a silent migraine skips the pain phase altogether.

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Like all migraines, the exact cause of a silent migraine is not completely understood. However, some research suggests the condition may be due to an electrical wave (i.e., neurons firing) that moves across the visual cortex in your brain, thus bringing about visual changes, according to the National Library of Medicine (NLM).

What Are the Triggers for Silent Migraines?

What's better known, though, are the triggers for silent migraines. These are similar to those for migraine headaches, Dr. Natbony says, including:

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  • Stress
  • Weather changes
  • Hormonal fluctuations
  • Shifts in your daily routine
  • Bright lights
  • Certain foods or medications
  • Sleep disturbances

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"It's thought that the trigger sets off a chain reaction in the brain leading to the release of inflammatory substances, which could cause nerve cells to become overactive," Dr. Natbony adds. "This could lead to a migraine aura without headache."

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Symptoms of Silent Migraine

Arguably the most obvious silent migraine symptom is an aura. This attack is "most commonly visual and results in flashing lights, spots, patterns or loss of vision," says Teshamae Monteith, MD, FAHS, a fellow of the American Headache Society and chief of the Headache Division at the University of Miami Miller School of Medicine.

Other symptoms include the following, Dr. Monteith says:

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  • Speech or language disturbances
  • Weakness
  • Numbness
  • Vertigo
  • Imbalance

Still other symptoms of the condition are the same as those associated with a typical migraine (i.e., one ‌with‌ a headache), per Mount Sinai, including:

  • Nausea
  • Dizziness
  • Sensitivity to light

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They typically occur at different stages during an episode.

How Long Does a Silent Migraine Last?

The duration of a silent migraine depends on the person. For some, a silent migraine can be as short as a few hours, while for others it can last for days, according to the Brain Center.

In general, a migraine can be broken down into four phases:

  • Prodrome (aka the warning)
  • Aura
  • Headache
  • Postdrome (or post-headache)

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But not everyone will progress through all four phases, Dr. Natbony says.

The headache phase, for example, can be skipped in those who have silent migraines. The phases are as follows, according to Dr. Natbony:

1. Prodrome

Essentially the warning of an impending episode, this phase occurs a day or two prior to the onset of an aura and usually involves symptoms such as food cravings, mood changes, exhaustion and increased thirst, among others, according to the NLM.

2. Aura

The duration of this stage often ranges from 5 to 60 minutes, with 20 minutes being the most typical length, Dr. Monteith says. "But, in some cases, it can be persistent and last for days to weeks."

3. Headache

This phase is typically skipped during a silent migraine attack. But it is usually when you'll feel the most pain and in a specific part of your head (like one side of your head, for example).

4. Postdrome

This phase can last hours to days and is often characterized by fatigue, irritability, brain fog, mood changes and an overall feeling of "blah," Dr. Natbony says.

She also notes that those who experience migraine auras without headache may or may not experience postdrome.

Silent Migraine Treatments

Most migraine treatments focus on pain relief, but because a silent migraine is characterized by an aura — not pain — treatment isn't all that available.

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Once an aura starts, pain medication can help prevent the headache pain phase, but it typically will not stop the aura itself, Dr. Natbony says. (And there's no reason or benefit to taking pain meds if you typically don't experience the headache part of a migraine.)

That being said, there are a few different avenues people who get silent migraines can consider depending on certain factors, such as the frequency and severity of their episodes.

1. Magnesium Oxide Supplements

While there aren't a lot of medications specifically tested for this type of migraine, some studies have found certain supplements — such as magnesium supplements — to be effective at treating silent migraines, according to a March 2022 review in ‌Nutrients.

"Magnesium plays a vital role in energy production, muscle and nerve function and may play a role in cortical spreading depression, which is the underlying mechanism for migraine aura," Dr. Natbony says.

"It's a good option for most people, as it is well-tolerated and effective when used consistently (although it takes at least three months of daily use to see benefit)," she adds.

So, how much should you take? The recommended daily dose is 400 to 600 milligrams per day, according to the American Migraine Foundation. And the recommended form is magnesium oxide — other forms, such as magnesium chloride, aren't well-absorbed and don't work the same way as magnesium oxide, so be sure to look for this specific ingredient on the label. Magnesium oxide can be found in the following product:

Warning

Always talk to your doctor before taking a supplement to make sure it's safe for you based on your health status, medications and medical history.

2. Preventive Medications

If your migraines are frequent and disabling, your doctor might prescribe medications to prevent them from happening in the first place.

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Such medications include lamotrigine — a type of anti-seizure medication that works by "decreasing the excitability of neurons in the brain, which can help to prevent spreading of electrical activity that underlies migraine aura," Dr. Natbony says.

Another one doctors may prescribe is calcitonin gene-related peptide (CGRP) inhibitors — a newer class of medications developed specifically for the prevention of migraine, per the Cleveland Clinic.

While lamotrigine is taken orally, anti-CGRP agents or medications are typically given by injection. Some CGRP inhibitors are also available for the acute treatment of migraines, and those are usually taken orally.

3. Lifestyle Changes

While natural remedies for headaches like heat and ice might be a good idea for treating migraines overall, they're not going to do much for a silent migraine given they're geared toward stopping pain.

However, lifestyle changes like getting ample shut-eye, decreasing stress, exercising regularly and avoiding known migraine triggers (such as certain foods, scents or activities) overall can help prevent attacks, Dr. Natbony says.

4. An sTMS Device

"One product on the market, an sTMS (transcranial magnetic stimulator) device called SAVI Dual by eNeura, can stop an aura in its tracks," Dr. Natbony says.

This gadget, when placed on the back of your head for a few seconds, sends tiny magnetic pulses to the surrounding head and neck area. It can both prevent and treat migraine aura with ‌and‌ without headache — and doesn't have known side effects, making it an especially good option for those who are sensitive to drugs, per the Migraine Trust.

"[The device] can be used at the start of an aura to shorten its duration," Dr. Natbony says. "It can also be used preventatively, twice a day, to reduce the frequency of migraine aura without headache episodes."

When to See a Doctor

Put simply, you should see your doctor if you have new or worsening migraine symptoms, including migraine aura without a headache. Your doctor can give you a proper diagnosis and treatment plan.

"If there is no history of migraine headache and/or aura that lasts more than an hour, you should see a doctor for a full evaluation and official diagnosis," Dr. Natbony says.

But what if you've already received a migraine diagnosis? Then you should probably schedule an appointment with your neurologist, "if neurological symptoms are persistent, prolonged, frequent or different in nature," Dr. Monteith says.

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references

Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.

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