Silent migraine - nothing to be silent about

Silent Migraine

Silent migraine is one name for a type of migraine attack that doesn't include a headache. As strange as it may sound, it's actually not all that unusual. Over the years, silent migraine has gone by other names, including acephalgic migraine, sans-migraine, migraine equivalent, eye migraine, visual migraine, ocular migraine, painless migraine or simply migraine aura without headache. Today it's usually called migraine aura without headache.



Migraine aura is a term used to describe many of the other symptoms that go along with migraine, but it's usually referring to visual symptoms. This might include seeing zig zags or flashing lights, or having dizziness or vertigo. It's estimated that only about 15% of migraineurs deal with aura. Read this article for more on migraine aura. There are actually a host of possible symptoms that can hit, usually before a headache stage, such as slurred speech, numbness, pain in other parts of your body such as in the face or on the skin, and ringing in the ears.

Interestingly, migraine aura without headache more often occurs later in life, and more often in men than in women.

The problem of misdiagnosis

As you may imagine, with so many symptoms in silent migraine, it's prone to misdiagnosis.  Sure, if you were to get a one-sided headache, or any headache, migraine might be suspected.  But without the headache stage, the migraine diagnosis is often missed.

I recently read an article by a patient who was first told he had had a mini-stroke, then he was diagnosed with things like hypoglycemia, meniere's disease (an inner ear disorder), depression, fibromyalgia and myofascial pain!  It's easy for silent migraine to be mistaken for many other diseases - and that's no help to the patient.

Even those who get "normal" migraine can get silent migraine from time to time.  It's estimated that 20% of migraineurs have had a silent migraine.  Of course, it's easier for someone with a history of migraine to recognize the symptoms.

Silent migraine has not gotten a lot of specific press, probably because it's often simply lumped in with other migraine.  Most of the migraine books I own don't specifically mention it in the index by any name, although they do talk about it here and there.  This can make it pretty frustrating for the patient looking for information.

Getting the right diagnosis

One challenge when it comes to diagnosis is that you really do need to rule out other disorders.  Obviously, if you've had a stroke you need to know about it, not just write it off.  Visual disturbances and hallucinations may be due to acephalgic migraine, but there also may be something wrong with your eyes.  Seizure issues may also come into play.  So if you're getting symptoms like the ones mentioned above - vertigo, visual disturbances, numbness, do see your doctor right away.

There are, however, some things you can do to ensure you get a quicker correct diagnosis.  Most importantly, be sure you have a family and personal medical history to show your doctor.  Migraine is a genetically based disease.  If you have migraine or related diseases in your family history, your doctor may suspect that you've experienced silent migraine.  (This is helpful, though still you may only find a connection in a minority of cases).  Also, be ready to describe your symptoms to the doctor.  Include even things like irritability and euphoria, yawning, stiff neck and difficulty finding the right word when you're talking.  If you've had more than one attack, and the symptoms are the same, that's an important clue.

Your doctor may order tests for you to rule our an organic disease.  This may include a CT scan or MRI, blood tests, and eye exams, depending on the type of symptoms you describe.

Treatment of silent migraine

Rare or mild occurrences of silent migraine may not require treatment at all.  However, for many people sans-migraine is not something to be shrugged off.  The symptoms can still be completely debilitating.  For cases like that, there is help.

Remember that silent migraine is still basically migraine.  It's a common misconception that migraine is simply a bad headache - it's actually a neurological disease, and headache is only one possible symptoms.  There are various types of treatment that work well for migraine, silent migraine included.

Abortive drugs are often helpful when it comes to silent migraine.  Sometimes something as simple as aspirin can stop the symptoms (especially effervescent aspirin - the kind that fizzes when you drop it into water).  Usually you want something fast acting, such as a beta-agonist inhalent (such as isoproterenol).  Also helpful are sublingual (under the tongue) nitroglycerin, meclofenamate (Meclomen, frequently used for arthritis), and naproxen sodium.  For prevention, calcium channel blockers, a common migraine preventative, may also be helpful.  Anti-seizure drugs are sometimes tried, such as topiramate (again, these are used for other types of migraine as well, not just silent migraine)  Talk to your doctor about the full range of migraine medication that's available today.

-->One of the major types of abortive migraine drugs, triptans, are not recommended.  For one thing, they don't act fast enough - you need something very quick and preferably early on in the aura to be effective.  For another thing, if an actual headache strikes later, you may want to take a triptan then.

Summary

In short, you're not crazy (and neither is the doctor or friend that may have told you about silent migraine)! There is

such a thing. It can be mild, or it could be severe enough to keep you home in bed. If you're experiencing these symptoms for the first time, it's important to see a doctor right away to rule out other diseases. Once you're comfortable with the diagnosis, there is lots of help available. If your symptoms are severe, this is certainly not something you need to live with. Fight back!

Other pages you may find helpful:
  • Types of eye migraines
  • Description of migraine symptoms
  • Free migraine and headache newsletter, HeadWay
  • Abortive medication
  • Preventative medication
  • Silent migraine is also sometimes called migraine syndrome without headaches



  • References: Post on silent migraine and diagnosis by Earl Blacklock, 1996; Migraine aura without headache by Donald M. Pedersen, William M. Wilson, George L. White, Jr., Richard T. Murdock, Kathleen B. Digre, Journal of Family Practice, May 1991; Effervescent Aspirin an effective migraine agent from Cephalalgia, Nov 2005; Ask the Expert from Harvard Medical School on optical migraine, July 2003; 'Migraine Aura without Headache' (silent migraine) article at the World Headache Alliance (link no longer available); Migraine aura without headache: Benign, but a diagnosis of exclusion by Dr Robert S Kunkel, June 2005.  This is actually a fascinating article if you want deeper investigation.  Visit the WHA page above and then right click the link to download the pdf file.