Silent migraines: Causes, symptoms and treatments

Reviewed by our clinical team

Silent migraines are unique in the fact that, unlike other types of migraine, they manifest without the pounding headache that people generally associate with the condition. Despite this, those that experience silent migraines know they can be just as uncomfortable and debilitating as ‘typical’ migraines.

In this article we'll take an in-depth look at silent migraines, shedding light on the causes behind them, exploring the symptoms, and discussing the treatment options available to those who experience this unique and often frightening condition.

What is a silent migraine?

When most people hear the word ‘migraine’, their thoughts likely immediately jump to headaches - but this isn’t always the case.

Silent migraines, also known as ‘migraine aura without headache’, generally occur with most or all of the symptoms of migraine - like aura, nausea and dizziness - without the head pain.

Although on the surface this sounds preferable to the more common type of migraine, migraine without aura, those living with the condition know it can be uncomfortable and frustrating in its own way. 

We don’t know the exact number of people who experience migraine aura without headache, but they likely make up a firm percentage of the 190,000 migraine attacks that occur every day in the UK.

Silent migraines can affect your vision, senses, and even cause temporary blindness. Migraines with aura can be very scary, so it’s important to know the symptoms as well as the treatment available. 

Silent migraine symptoms

Silent migraines typically consist of three main phases: prodrome, aura, and postdrome. While these phases might not include the typical headache, they are still noticeable, uncomfortable, and can be disruptive to day-to-day life. 

Prodrome

In the prodrome phase, which often precedes a silent migraine, you might experience: 

• Subtle mood shifts
• Changes in energy levels
• Nausea
• Muscle stiffness  

Fatigue, sleep pattern changes, and unusual cravings are also potential symptoms, but it differs from person to person. Those who’ve experienced silent migraines before often take these as a warning sign that a migraine is on the way. 

Aura

The next stage of a silent migraine is known as ‘aura’, which usually manifests as visual disturbances. Aura symptoms include: 

• Bright or flashing lights in front of the eyes
• Blurring
• Zigzag lines
• White or coloured dots or stars
• Tunnel vision or temporary loss of sight
• Stationary objects that appear to move
• Objects that appear larger or smaller than they are
• Numbness and tingling
• Speech difficulties 
• Dizziness or balance problems
• Loss of consciousness, in rare cases 

Aura symptoms can vary dramatically from person to person and can be very frightening and anxiety-inducing. Those who have never experienced an aura before might assume they are having a more serious attack, such as a stroke. This usually isn’t the case, but if these symptoms happen out of the blue, or are accompanied by other symptoms such as physical weakness or slurred speech, you should call 999 immediately. 

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Postdrome

Also known as a migraine ‘hangover’, the postdrome phase can last for 24 to 48 hours and may manifest with symptoms such as:

• Aches and pains
• Difficulty concentrating
• Dizziness
• Euphoria or depression
• Fatigue

Silent migraine causes

As with most types of migraine, we don’t really know what it is that triggers silent migraines. It could be a response to the release of a particular chemical, like with CGRP migraines, or another type of abnormal brain response, but there’s no firm evidence as yet. 

What we do know is that there are a few common potential triggers reported anecdotally by people who experience migraines.

These include: 

• Stress - emotional and physical stress have been linked to migraines.
• Diet - some foods like aged cheese, caffeine, and alcohol have all been reported as potential triggers, potentially due to the fact they contain the chemical tyramine.
• Changes in sleep patterns - lack of sleep or too much sleep have both been reported as migraine triggers.
• Hormones - hormonal changes, especially in women during their menstrual cycles, have been associated with migraines.
• Environmental factors - bright lights, strong smells, loud noises, and even the weather can all be triggers for some people. 

Understanding your own triggers is an important step in helping you manage your migraines better. Keep in mind that everyone responds differently, and what affects one person might not affect another in the same way. The best thing to do is to discuss your own triggers with your GP so they can advise you on the best course of action. 

Silent migraine treatment

Silent migraines can often be treated with the same medication as other migraines, even when they don’t manifest with head pain. Some of the most popular migraine treatments include: 

Vydura (Rimegepant) 

Vydura, alternatively known as rimegepant, is a wafer-type medication designed for preventing and managing migraines. It’s part of the gepant class of medications, and works by inhibiting CGRP neurotransmitter receptors in the brain, easing the symptoms associated with migraines. One study showed participants had, on average, 4.3 fewer monthly migraine days, and reported a 50% reduction in total monthly migraine days whilst taking Vydura. 

Sumatriptan

Sumatriptan is a member of a category of migraine medications known as triptans, and works by constricting blood vessels and lessening inflammation in the brain to minimise the symptoms of migraines, including aura and nausea. Sumatriptan is available in multiple forms, but most commonly as tablets. 

Rizatriptan

Another type of triptan, rizatriptan works in a similar way to sumatriptan, tightening blood vessels and reducing inflammation to mitigate the most debilitating migraine symptoms. Available in tablet form, rizatriptan is one of the most convenient migraine relief medications we offer.

Conclusion

Although silent migraines don’t cause headaches in the same way other types of chronic migraine conditions, such as hemiplegic migraines, do, they can still be very uncomfortable, frightening, and impact the quality of life of those that experience them. Nobody should have to live with the symptoms of migraines alone, so it’s important to know that help is available if you think you might be experiencing silent migraines.

To find the best treatment for you, speak to your GP. They’ll talk through your symptoms with you and help you find the most suitable course of action, minimising the discomfort of silent migraines and allowing you to live your life without worry. 

References

https://www.nice.org.uk/guidance/ta260/documents/migraine-chronic-botulinum-toxin-type-a-final-scope
https://headachejournal.onlinelibrary.wiley.com/doi/full/10.1111/j.1526-4610.2009.01443.x 
https://www.medicines.org.uk/emc/product/13928/pil