Silent migraine symptoms: What are the early signs of a silent migraine?

Overview: What does a silent migraine feel like?

A silent migraine isn’t exactly silent. There are noticeable and sometimes severe symptoms that can last from anywhere from a few seconds to a few hours to even several days. A headache is actually absent, so it’s more accurately called a painless migraine. Doctors sometimes call it “acephalgic migraine,” which means “migraine without head pain.” The International Headache Society’s International Classification of Headache Disorders, 3rd edition (ICHD-3), the official headache diagnostic manual, calls it “typical aura without headache.” 

A silent migraine involves having one or more symptoms of a classic migraine aura without a following headache. The most common symptoms are visual disturbances, but some people might have smell or hearing problems, numbness or tingling, sensitivity to light, trouble talking, or weakness on one side of the body. They may also experience warning signs, such as food cravings, mood changes, or restlessness in the hours or days before having aura symptoms. Avoiding the headache may seem like an improvement, but aura symptoms can be severe enough to cause momentary disability. They’re also frightening because they’re so similar to symptoms of more severe problems like strokes or seizures.

What are the early signs of a silent migraine?

Some people may experience early signs of a silent migraine before the onset of aura symptoms. Called prodromal symptoms, the most common early warning signs include:

• Food cravings

• Irritability

• Fatigue

• Neck stiffness

However, there are many possible symptoms associated with the prodromal phase of a migraine:

• Frequent yawning

• Frequent urination

• Restlessness

• Trouble sleeping

• Sluggishness

• Feeling cold

• Sweating

• Stiff muscles

• Feeling sick to the stomach

• Fluid retention and swelling

• Sensitivity to light or loud noises

Other silent migraine symptoms

The hallmark symptoms of a typical migraine aura are visual symptoms. 98% of people who have migraines with auras experience visual disturbances, including:

• Blurring

• Partial vision loss

• Double vision

• Jagged, zigzag lines

• Flashing lights or sparks 

• Haloes

• Blind spots in the field of vision

• Tunnel vision

Other sensory disturbances are the next most common set of symptoms in people with migraine with aura. These include:

• Ringing in the ears

• Hearing noises that aren’t there

• Partial or temporary loss of hearing

• Strange smells

• Numbness or tingling

Other symptoms related to movement or balance include:

• Muscle weakness

• Poor coordination

• Dizziness

Less commonly experienced symptoms affect language and speech, so people may find it hard to speak during an aura. Finally, nausea and vomiting are common symptoms of a migraine aura.

RELATED: Migraine with aura symptoms: what are the early signs of migraine with aura?

Silent migraine vs. stroke

Because there is no headache, it’s easy to mistake a silent migraine for a transient ischemic attack (TIA), a mild and short-lived stroke. If the aura lasts for hours or days, it’s easy to worry that it’s a regular stroke. On the other hand, it’s easy to mistake a transient ischemic attack for a silent migraine, a more hazardous mistake. For this reason, healthcare professionals often evaluate people for strokes or TIAs if they start having silent migraines, particularly if they first experience silent migraines after the age of 40 years, experience a very short or very long silent migraine, or primarily have negative symptoms. 

There are a few clues that may help detect whether it’s a silent migraine or a stroke. Positive symptoms, such as flashes, haloes, and hearing things, are usually signs of an aura. Aura symptoms develop gradually, but strokes and ministrokes hit suddenly and without warning. Finally, visual disturbances are usually present in both eyes during a silent migraine. A stroke or TIA usually affects just one eye. However, do not diagnose yourself. If you experience a silent migraine and worry that it might be a stroke or TIA, call a healthcare provider.

RELATED: How to recognize the signs of a stroke

Stages of silent migraine: How can I tell which one I have?

Common migraines typically have four stages: 

• A prodrome phase involving anticipatory symptoms like food cravings and mood changes

• An aura stage

• Headache

• Hangover (postdrome). 

Silent migraines are typically described as sometimes having an early, prodromal stage. This is then followed by aura, but the migraine ends when the aura symptoms clear. 

When to see a doctor for silent migraine symptoms

It’s not uncommon for people to see a healthcare provider or go to an emergency room the first time they experience a silent migraine. The symptoms are scary since they share much in common with the symptoms of a stroke. Anyone who experiences a silent migraine and is worried that it’s a stroke, get medical help. This is especially true for: 

• People who have their first silent migraine after the age of 40 years

• People who primarily have negative symptoms (loss of function), such as vision loss, numbness, or weakness

• People who have a very short-lived aura (a few seconds) or one that persists for hours or days

There is a possibility that the aura symptoms are due to a more serious disorder, such as stroke, transient ischemic attack (ministroke), meningitis, seizure, or problems with the retina or optic nerve. To rule out more serious disorders, a healthcare provider or neurologist will take:

• A medical history

• A physical exam

• Blood tests

• An MRI or CT scan of the head 

An ophthalmologist may need to examine the retina to make sure the eye is healthy. 

Migraine aura without headache is diagnosed when there’s no evidence of any other neurological or eye disorder.

Complications of a silent migraine

People who experience migraine auras without headache are at risk of complications, such as:

• Increased risk of stroke (migrainous stroke)

• Migraine aura-triggered seizures

• Persistent aura (lasting several days to a week)

• Temporary disability

How to treat silent migraine symptoms

Treatment options for silent migraines are relatively limited because there’s no headache, so typical migraine medications may not help much. There’s very little research on treating silent migraines, so people are treated on a case-by-case basis.

Preventive treatment options include daily doses of one or more types of drugs or supplements:

• Magnesium supplements: Magnesium is believed to prevent the neurological disruption that starts migraines.

• Low-dose aspirin: One study showed that 93% of patients who had migraines with aura experienced aura less frequently when on low-dose daily aspirin and almost half had complete remission of their symptoms.

• Lamotrigine: This anticonvulsant has been found to reduce the incidence of aura

• Calcium channel blockers: This group of medications can prevent blood vessel changes, which can prevent auras from occurring.

Most treatments for an acute migraine headache, such as triptans or ergots, treat the mechanisms that cause the headache, which can last for hours or days. People should not take triptans during the aura phase of a headache, but they should instead take them as soon as the headache pain starts. 

An acute aura without headache is typically brief—usually less than an hour in duration. Acute treatment may not be needed unless the aura lasts a long time or is severely debilitating. In those cases, healthcare providers will use medications that are effective at treating persistent aura. Furosemide and lamotrigine are often used to treat persistent auras without headache so they may help relieve auras that don’t get better in a short time. Painkillers, such as ibuprofen, may help reduce short-term aura symptoms. Anti-nausea drugs can lessen nausea and vomiting.

Living with a silent migraine

Lifestyle changes can help reduce the incidence and severity of aura episodes, including:

• Avoiding migraine triggers, such as stress, anxiety, caffeine, alcohol, or hormonal contraceptives

• Eating a healthy diet

• Eating regular meals

• Exercising

• Reducing stress

• Practicing good sleep hygiene

RELATED: What is migraine? Your guide to talking about the condition

What’s next? Additional resources for people with silent migraine symptoms

Test and diagnostics

• Migraine aura without headache, American Migraine Foundation (2021)

• The International Classification of Headache Disorders, 3, International Headache Society (2018)

Treatments

• Aura without headache or “silent migraine”: a guide, American Migraine Foundation (2021)

• Calcium channel blockers, National Headache Foundation (2023)

• Magnesium and migraine, American Migraine Foundation (2021)

• What is a silent migraine and how do you treat it?, SingleCare (2021)

Scientific studies and clinical trials

• Aspirin prophylaxis for migraine with aura: an observational case series, European Neurology(2017)

• Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura, Journal of Neurology, Neurosurgery & Psychiatry (2005)

• Persistent negative visual aura in migraine without headache: a case report, Journal of Medical Case Reports (2014)