What is a Silent Migraine?
A silent migraine is unique because it causes all the same symptoms as a typical migraine, minus the pain. Silent migraines are also referred to as a typical aura without headache (TAWH). Attacks consist of visual, speech, and/or sensory symptoms absent of motor weakness. These symptoms develop gradually, typically lasting no longer than one hour, and are completely reversible. They typically appear before other migraine symptoms, such as photophobia and nausea.
What is a Headache Without Aura?
TAWH occurs in about 3% of women and 1% of men who are migraine patients. TAWH is also higher in people between the ages of 20 and 39 years old, and 60 and 69 years old.
These people usually had a history of migraines with aura when they were younger. However, there are few current case studies or reports on recurrent TAWH attacks that lasted over 30 years.
What is an Aura?
According to the American Migraine Foundation, an aura is “an episodic and transient event that evolves over several minutes and generally lasts between 5 and 60 minutes." An aura can be visual, speech, or sensory disturbances as well as motor, brainstem, and retinal. We will focus mainly on visual, speech, and sensory disturbances as these are the auras associated with silent migraines.
Visual Aura
Visual aura is the most common type of aura experienced by patients with migraines with aura (over 90%). Most people who have migraine with aura experience transient visual signs and symptoms that appear to begin in the center of the field of vision and spread outward.
Examples of these signs and symptoms include blind spots or scotomas, zigzag lines that gradually spread across your field of vision, flashing lights, and vision changes.
Sensory Disturbances
Sensory disturbances occur second in frequency to visual aura. This is experienced as a feeling of pins and needles, which starts in one area of the body and gradually spreads unilaterally, affecting either a greater or smaller part of the body, face, and/or tongue.
Speech Disturbances
Speech disturbances are reported less frequently, but usually consist of language difficulties and/or aphasia. Aphasia, by definition on the National Aphasia Association website, is an impairment of language, affecting the production or comprehension of speech and the ability to read and write.
Treating a Silent Migraine
Treatment for a silent migraine is a difficult process. Each individual is usually managed on a case-by-case basis. While there are no FDA-approved drugs for the specific treatment of typical aura without headache, small studies suggest the use of aspirin, magnesium and lamotrigine. Use of oral triptans or NSAIDs are not usually taken as they do not take effect until after the aura is over.
Risks and Complications
There is an increase of stroke if you have migraine with aura, with or without headache. Dr. Gretchen Tietjen, chair of the Department of Neurology at the University of Toledo, says that half of the 800,000 strokes annually are among women and about 2,000 to 3,000 could be related to migraine. Using hormone treatments that contain estrogen are also associated with an increased risk of stroke among these patients.
While seeking a diagnosis for a silent migraine, your physician may want to rule out other conditions such as epilepsy and TIA (transient ischemic attacks). To make getting a clear and concise diagnosis easier, keeping an aura diary will help to track which type of disturbances you are experiencing and how they present to you. This diary can help the physician distinguish your symptoms and clarify the diagnosis.
Cause and Prevalence of Silent Migraines
As with all migraine types, typical aura without headache has no exact cause or is entirely understood. Similar triggers that bring on an attack with migraine, such as stress, certain foods, medications, poor sleep hygiene, and menstruation, can also be factors in what triggers a silent migraine.
It is valuable to learn what your specific triggers are through tracking them in a diary and making certain lifestyle changes to help reduce the impact that triggers on your migraine. Tracking this information will also be helpful for your doctor when trying to figure out causes and treatment plans.
Final Notes
While silent migraines aren't common, they do happen to many people around the world. There are different ways they can present themselves, and symptoms will vary between people. However, it should be noted that the main similarity is that people experience migraine symptoms without the common pain that a normal headache brings.
If you experience visual auras, speech disturbances, or sensory disturbances, be sure to make an appointment with your doctor. They will be able to properly diagnose you and your symptoms, and help you develop a treatment plan.