Can You Have Migraine Without Headache Pain?

Migraine attacks may not come with headache pain. Here’s what it means if you experience migraine without headache, previously called “silent migraine.”

In the common — and incorrect — understanding of migraine, this complicated condition is often considered to be synonymous with “headache.”

If you have migraine, you know an attack is much more than just the headache stage, and symptoms frequently go beyond headaches.

For some people, a headache may not even be part of the equation. That’s actually a particular kind of migraine.

Here’s everything you need to know about migraine without headache pain, including common symptoms, how it’s diagnosed, and treatment options.

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Can you have migraine without headache pain?

Many people with migraine experience headache pain as a symptom during migraine attacks.

For other people, headache pain may not factor into an attack at all. In this case, is it still migraine?

The answer is yes. Not all forms of migraine come with headaches, and it’s entirely possible to have migraine without headache pain.

Migraine without headache is officially known as “typical aura without headache,” though it’s commonly called “migraine aura without a headache.”

Previously, the medical term was “acephalgic migraine.” However, that term has been removed from the International Classification of Headache Disorders (ICHD), an official diagnostic tool for all things headache and migraine.

Migraine aura without headache has also been referred to as “silent migraine,” but this name can be problematic.

Calling migraine “silent” can minimize the condition and diminish the experiences of people who experience it — inadvertently or not.

Even if there’s no headache, you’re still experiencing migraine. There’s nothing silent about that.

What is migraine aura without headache?

Migraine aura without headache is summed up well by its name. This type of migraine is characterized by some type (or types) of aura. Unlike other forms of migraine with aura, these symptoms are not followed by headache.

It’s also possible to experience some migraine aura episodes without headache and others with headache.

Migraine aura without headache is relatively rare: only about 4% of people with migraine experience it, according to the American Migraine Foundation.

Phases of migraine aura without headache

Like other types of migraine, migraine aura without headache can be split into phases.

These phases include:

• prodrome: early symptoms before a migraine episode, sometimes also called the premonitory phase
• aura: neurological symptoms impacting the senses and/or speech and language processing
• postdrome: lingering symptoms after aura, sometimes called migraine hangover

What is migraine aura?

Aura is the central part of this type of migraine. So, what exactly is aura?

Aura is the overarching term for any and all of the visual, sensory, speech, auditory, or motor symptoms that may occur during any migraine with aura episode. About 25% of people with migraine experience aura.

Migraine auras can manifest in a number of different ways, and they can happen with or without headache pain.

Migraine aura symptoms

Aura symptoms in migraine aura without headache are generally limited to typical aura, meaning:

• visual disturbances in both eyes
• sensory disturbances in various parts of the body
• trouble with speech and language

Auras develop gradually, ramping up over several minutes. Some people experience one aura per episode, while others may experience multiple symptoms. Auras may occur one after another or simultaneously.

Each aura can take anywhere from 5 minutes to 1 hour. It’s possible to experience multiple aura symptoms over the course of a couple of hours.

For example, a person experiencing a migraine aura without a headache may have visual auras for 1 hour and sensory auras for 1 hour, for a total of a 2-hour aura phase.

Keep in mind

Auras can be frightening, distressing, and frustrating in the moment. It’s important to remember that aura symptoms are fully reversible and don’t have any permanent neurological effects.

These disturbances go away entirely after they’ve run their course — usually in no more than an hour.

What are the symptoms of migraine aura without headache?

Each person’s experience of migraine is unique, regardless of the type of migraine. Still, some symptoms are more widespread than others.

Here are some of the more common symptoms of migraine aura without headache.

Types of auras

Auras are the primary symptom of this type of migraine. Now that we understand what auras are, let’s break down how they can manifest in migraine aura without headache.

Aura types include:

• visual
• sensory
• speech and language

Visual aura

Over 90% of people who experience migraine with aura experience visual auras. Visual auras appear in both eyes, though they may be more present in one eye or the other. The visual disturbances may gradually grow in size from a smaller focal point.

For people with migraine aura without headache, visual auras may include:

• shimmering zigzag lines or bright lines
• bright spots, dots, or stars
• bright flashes or flickers of light
• blurred vision
• blind spots or total loss of vision

Sensory aura

Sensory auras are also common: 36% of people who have migraine with aura experience them. Sensory auras generally occur on one side of the body, face, or mouth at a time. These symptoms may be felt in a small area or spread outward.

For people who experience migraine aura without headache, sensations from sensory auras can include:

• tingling
• pins and needles
• numbness

Speech and language or aphasic aura

Speech and language auras occur in 10% of people who experience migraine with aura. This type of aura is sometimes referred to as “aphasic aura.”

People with migraine aura without headache may experience speech and language auras as:

• difficulty with word recall
• difficulty with verbal comprehension
• difficulty with articulation
• slowed speaking rate
• fatigue in the lip, mouth, and tongue muscles
• difficulty with physically forming words
• difficulty with long periods of speech

All auras are temporary and will usually go away in about an hour at most.

Other symptoms of migraine aura without headache

Auras are not the only symptom of migraine aura without headache.

People may experience other symptoms typically associated with migraine, including:

• sensitivity to light, sound, and smell
• nausea
• vomiting
• dizziness
• neck pain
• muscle stiffness
• body aches
• insomnia
• fatigue
• depressed mood
• difficulty concentrating

Is it migraine aura without headache, or something else?

Like with other types of migraine, diagnosis of migraine aura without headache is often based on your symptoms and a thorough review of your medical history. A neurological exam is usually necessary.

A migraine journal can help you track your symptoms to give your doctor a full picture for diagnosis.

In your journal, consider including:

• a complete list of symptoms and specific auras
• what auras look, feel, and sound like
• when auras occur and how long they last
• frequency and duration of migraine attacks and symptoms

It can be difficult to diagnose migraine aura without headache. Your doctor will likely additional tests to rule out other conditions like ischemic stroke or seizure.

It’s essential to talk with your doctor if you frequently experience migraine aura without headache because it may be due to other serious conditions that require treatment.

In most instances, migraine auras are not cause for immediate concern, however scary they may feel in the moment.

When auras occur relatively infrequently, ramp up over time during the episode, and last no longer than 1 hour, they’re likely related to migraine aura without headache.

How to treat migraine aura without headache

Treating migraine aura without headache can be difficult, depending on which symptoms you’re addressing.

Currently, options for treating migraine aura are limited. More research is needed to establish treatment methods tailored specifically to this category of migraine.

Typical migraine treatments

Migraine aura without headache is often treated on a case-by-case basis, and many treatment strategies overlap with those used for other types of migraine, including prescribing medications like triptans and NSAIDs.

However, these typical migraine medications don’t treat everything. Since aura symptoms last a relatively short amount of time, they may be over before you feel the effects of your medication.

Still, these medications may be able to treat other symptoms of migraine aura without headache, like nausea and dizziness.

High blood pressure medication

According to the American Migraine Foundation, calcium channel blockers — a type of medication typically used for high blood pressure — may work as a preventive treatment for migraine aura without headache.

However, more research is needed.

Prevention

Avoiding migraine triggers, getting enough sleep, and reducing stress may also help you prevent migraine aura without headache.

The bottom line

Not all migraine episodes come with headache pain. This type of migraine is known as migraine aura without headache, previously called acephalgic migraine or silent migraine.

Migraine aura without headache is characterized by visual, sensory, and/or speech and language auras, as well as typical migraine symptoms like light and noise sensitivity, nausea, and dizziness.

Auras usually last no longer than 1 hour and then go away entirely, while other symptoms may continue.

While specific aura treatments still need to be developed, migraine aura without headache can be treated with typical prescription and over-the-counter migraine medications. Calcium channel blockers may also be an option for aura treatment.