If you get migraines, you may know how painful the condition can be. For many people, the symptoms of a typical migraine include sharp pain that may not subside for hours. But for others, the condition may have different symptoms.
Some people develop migraines that don’t cause pain. These are often called “silent migraines.” Even though they don’t cause physical pain, silent migraines may trigger other symptoms that can be debilitating.
Classic migraines may be accompanied by symptoms other than a headache. Some people experience visual disturbances and sensory symptoms known as “aura” before pain hits.
According to the American Migraine Association, aura symptoms are often progressive and usually end once your headache begins, although they may remain until your headache is gone. Aura symptoms may include:
- blurry vision
- light sensitivity
- vision loss
- seeing zigzags or squiggly lines
- difficulty speaking
- abdominal pain
Silent migraines occur when you have aura symptoms without a headache. They typically last from a few minutes up to an hour. Some people have chronic migraines that last for days, weeks, or months, but this isn’t typical for silent migraines.
Because migraines are usually associated with significant pain, silent migraines may seem like a paradox. They’re thought to have a genetic cause, but it’s unclear exactly why they occur. Migraines may be caused by the brain’s difficulty adjusting to sensory stimulation such as lights and noise. Changes in chemicals and blood vessels in the brain may also be factors.
Over time, most people figure out what triggers their migraines. The triggers may be environmental, related to food, or physiological. There are hundreds of potential migraine triggers such as:
- bright lights
- fermented foods
- caffeinated drinks
- barometric changes
- chemical preservatives, colorings, and flavorings
- eye strain
- neck problems
- sinus problems
- too much sleep
- too little sleep
- menstruation and other hormonal changes
Some medications may also cause migraines such as oral contraceptives and medications that open the blood vessels, or vasodilators.
Your migraine risk, silent or otherwise, is higher if you:
- have a family history of migraines
- are under age 40
- are a woman
- are menstruating, pregnant, or going through menopause
Aura symptoms may mimic symptoms of other serious conditions such as ministrokes, strokes, and meningitis. For this reason, you shouldn’t self-diagnose a silent migraine. If you experience signs of aura for the first time, contact your doctor so that you can get a diagnosis.
Your doctor may be able to diagnose silent migraines based on your family history and a physical exam. If the symptoms are severe or new, they may order tests such as:
- blood tests
- CT scans
- MRI scans
- a spinal tap
If your migraines are infrequent, short in duration, and not severe, you may not need treatment. If they often happen and impact your ability to perform daily tasks or enjoy life, you should consider treatment options.
There’s no cure for migraines, but medication can help control symptoms. Treatments for silent migraines are the same as those for migraines with headaches.
Over-the-counter medications, such as the following, may help treat the symptoms of acute migraines:
Though caffeine may be a migraine trigger, it may also help ease acute migraine symptoms. Some people find drinking a cup of coffee or taking an Excedrin Migraine, which contains caffeine, helps. If you get silent migraines accompanied by nausea and vomiting, your doctor may prescribe antinausea medications.
If you experience migraines often, you may be advised to take preventive medications. These include cardiovascular drugs such as beta-blockers, including propranolol and metoprolol. Calcium channel blockers, such as verapamil and diltiazem, are other options. Your doctor may also prescribe tricyclic antidepressants, such as amitriptyline or nortriptyline.
Some prescription migraine treatments have side effects. For this reason, some people try alternative treatments before prescription drugs. Alternative options may include:
- massage therapy
- behavioral therapy
These treatments are often effective in easing stress, which can be a migraine trigger. They may also relieve acute episodes.
Your first step in preventing silent migraines is to identify your triggers. To do this, keep a migraine diary and write down when each migraine occurred, how long it lasted, and what you were doing before and when it struck. Be sure to note any foods or beverages you consumed, as well as any medications you took before the migraine began.
Once you’ve identified your triggers, you should avoid them. This may mean modifying your diet or avoiding noisy social situations.
If stress is a trigger for you, try practicing stress management techniques such as writing in a journal, meditating, or doing exercises such as yoga.
Take these steps to get on a regular sleep schedule and prevent insomnia:
- Go to bed at the same time each night.
- Avoid caffeine and other stimulants.
- Keep your bedroom cool and dark at night.
- Consider investing in a fan or white noise machine to block out noises that may keep you awake.
If you’re a smoker and get migraines, you should try to quit. A study published in Neurology found an increased risk of stroke in older smokers who have migraines.
Silent migraines vary in how much they impact day-to-day life. Some people may experience them rarely, in short duration, and with few symptoms. Others experience them daily with severe symptoms. Since silent migraines don’t cause pain, you may experience aura symptoms without realizing you’re having a migraine. Some people dismiss the symptoms as eyestrain or stress.
If you have silent migraines and suddenly develop a terrible headache, confusion, weakness, or other aura symptoms that aren’t normal for you, get emergency medical help to rule out a stroke or other neurological condition. You shouldn’t assume you’re having a classic migraine.
Since the symptoms may not be obvious, silent migraines may be underreported and undermanaged. Contact your doctor if you think you have silent migraines. Once you receive a diagnosis, you can review treatment options and begin to make lifestyle changes to manage triggers.
Talking to others who understand what you’re going through can also help you better identify and manage silent migraines. Our free app, Migraine Healthline, connects you with real people who experience migraines. Ask questions, seek advice, and make connections with others who get it. Download the app for iPhone or Android.