Medically reviewed by Dr. Jin Li
Most people equate the word “migraine” with “headache,” so it may come as a surprise that you can, in fact, have a migraine without head pain. When people experience vision problems, numbness or trouble finding words that come with a typical migraine, but no headache follows, doctors call it migraine aura without headache, or silent migraine. This condition is more common than you may think.
What does a silent migraine feel like?
A silent migraine can often look much like a typical migraine, minus the throbbing pain. Common symptoms include:
- Flashing lights, zigzag lines or blind spots in your vision
- Numbness or tingling that starts in the hand and moves up into the arm or face
- Trouble speaking or finding the right words
- Nausea
- Sensitivity to light, sound or smell
- Dizziness
These symptoms usually build over 5 to 20 minutes and can last up to an hour.
Why does this happen?
Migraine is a whole-body neurological event. In a typical migraine with aura, the aura phase (the visual and sensory changes) comes before the headache phase. In a silent migraine, the aura happens, but the headache phase doesn’t follow.
Some people only ever have silent migraines. Others usually get the full migraine with pain, but occasionally have an episode without it.
Who gets silent migraines?
Because silent migraines do not cause head pain, their symptoms can look like signs of something more serious, such as a stroke or seizure. This is one reason it’s important to reach out to a doctor about any new or unusual neurological symptoms, even if you don’t have a traditional headache.
A neurologist can rule out other causes and help you figure out whether what you’re experiencing fits the pattern of silent migraine. Keeping a symptom diary, tracking when episodes happen and what symptoms arise, can help your doctor make an accurate diagnosis.
How are silent migraines treated?
It is worth knowing that aura symptoms are usually brief and go away on their own, and there is no quick medication proven to reliably stop an aura once it starts. Management focuses on comfort during an episode and, when attacks are frequent or disabling, on prevention.
Treatment is usually similar to treatment for typical migraines and can include:
- Preventive medications, such as beta-blockers or anti-seizure drugs, if episodes happen frequently
- Anti-nausea medication for symptom relief during an episode
- Identifying and avoiding personal triggers, such as stress, poor sleep or certain foods
- Lifestyle changes, including a regular sleep schedule and stress management
When should you see a doctor?
If you notice visual disturbances, numbness or trouble speaking, even without a headache, you should get it checked out. These symptoms can overlap with more urgent conditions, so a proper evaluation is important.
When should you seek urgent help?
This is the most important part. Because there is no headache, the symptoms of a silent migraine can look like signs of something more serious, such as a stroke, mini-stroke (TIA), or seizure.
Get medical attention right away — call emergency services — if you have:
- Sudden weakness or numbness on one side of the face or body
- Sudden trouble speaking or understanding speech
- Symptoms that come on abruptly (over seconds) rather than gradually
- Vision loss in one eye, the worst headache of your life, confusion, or fainting
Be extra cautious if these symptoms are new and you are over 50, or if you have risk factors such as high blood pressure, diabetes, high cholesterol, smoking, or heart disease. New neurological symptoms in this situation should always be checked promptly, even without a headache.
If you are dealing with migraine symptoms, with or without pain, our neurology team can help you find the answers and treatment plan that make sense for you. Schedule an appointment today.