A migraine attack can occur without pain. This does not mean a migraine aura that is not followed by a pain phase, but the presence of migraine-related symptoms without pain. Migraine-related symptoms refer to neurological and autonomic symptoms associated with a migraine attack. Aneurysmal migraines may resemble abdominal migraine attacks, but in the latter, sensory sensitization is absent. Aneurysmal migraine is poorly studied and is not included in the International Classification of Headache Disorders ( ICHD-3). ). My own observation is that pain-free migraines seem to occur especially during the migraine remission phase, but occasionally even in 20-year-olds as an addition to painful migraine attacks.
Typical symptoms
During a non-traumatic migraine, the most common symptoms are nausea and sensitivity to light, sound, and smell. Sensitivity to smell is not a criterion for migraine, although it is a very common symptom during a migraine attack. Usually, sensitivity to smell occurs with nausea.
Vomiting is not an uncommon symptom in atrial migraine. Many also experience extreme fatigue, sweating, paleness, chills, and fluctuations in blood pressure or pulse due to autonomic nervous system dysfunction. Atrial migraine often requires lying down. In addition, patients may experience stomach upset, such as diarrhea or constipation.
The attack lasts the typical 4–72 hours for migraines. Migraine-specific medications, or triptans, work to some extent, but prochlorperazine is probably at least as good. After the attack, the same symptoms as in a regular migraine may occur: fatigue, low mood, or euphoria.
Avitriptan and pain-free migraine
The Turku Headache Center was conducting research on avitriptan in the early 1990s. As a tablet, it worked exceptionally quickly for migraine pain, even within 20–30 minutes, but it had no effect on associated symptoms.
The subjects described the drug as eliminating the headache but leaving the migraine behind. Functional capacity did not return simply by eliminating the pain. This taught us a lot about the impact of migraine comorbidities on functional capacity. However, avitriptan never reached pharmacies.
Summary
Aneurysmal migraine is a difficult-to-recognize form of migraine that, despite the absence of pain, severely affects functional ability. Abdominal migraine is somewhat similar, but the lack of sensory sensitization distinguishes these two forms of migraine.
Markku Nissilä, neurology specialist
Frequently asked questions about painless migraines
Can migraines occur without pain?
Yes. A migraine attack can occur without a headache, in which case symptoms include nausea, sensory sensitivity, and fatigue.
Is this different from a migraine aura without a headache?
Yes. Migraine without pain is associated with associated symptoms, while aura without headache is a neurological phenomenon before or without the pain phase.
Why is migraine without pain difficult to recognize?
Because pain is absent, the symptoms may resemble other conditions, such as abdominal migraines or blood pressure fluctuations.
How is it treated?
Triptans can relieve symptoms, but other medications such as prochlorperazine can also help. If necessary, preventive medication may be useful.
Is a migraine without pain dangerous?
Usually not, but it is a good idea to confirm the cause of the symptoms with a neurologist's examination, especially if they differ from previous ones.
Read more and find natural help
Many factors contribute to migraines – including neck muscle tension and stress.
Discover the Atlas Care device , which relaxes the muscles at the base of the skull and relieves the symptoms of migraines and tension headaches.