Migraine aura without headache is a recognized form of migraine characterized by aura symptoms such as visual disturbances, numbness, dizziness, or speech difficulties without the actual headache phase. Sometimes the term "silent migraine" is used for this, but it is a distinct matter and the subject of the next blog post.
Symptoms and prevalence
Migraine aura symptoms may include:
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Visual field disturbances, such as flickering lights, zigzag patterns, or blind spots in the field of vision.
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Sensory disturbances, tingling, or numbness in the upper limbs and face.
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Balance problems, dizziness, and feelings of confusion.
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Difficulty with speech production.
Migraine aura without headache is rare. However, the natural course of migraine, especially in women, includes the emergence of visual migraine auras during menopause, even if migraines had not occurred previously. The link between the aura and the headache phase usually disappears quickly, and auras may occur even several times a day. In the context of a long history of migraine, the emergence of auras is a phenomenon that anticipates the fading of migraines.
Identification and differential diagnosis
Migraine aura without headache can be more difficult to identify because the headache is missing and the symptom profile may resemble, for example, a TIA (transient ischemic attack) or an epileptic seizure. To confirm the diagnosis, it is important to rule out other neurological causes, especially if the symptoms are occurring for the first time or are different than before. If the aura starts directly as numbness without visual disturbances, it is urgent to have the matter investigated. Sometimes, the onset of auras occurs simultaneously with a rise in blood pressure.
Treatment and monitoring
In the treatment of migraine auras, triptans (targeted migraine medications) are not effective, but they are not dangerous either. When the aura is of typical duration, i.e., about 20 minutes, oral medications are practically of no significance. For long auras, i.e., those lasting over half an hour, treatment with acetazolamide—which is now a medication requiring special authorization—may be considered on a case-by-case basis. An aura should not last longer than an hour. Auras that occur disturbingly often are worth treating with regularly taken preventive medication, such as candesartan. Other options include lamotrigine (which only works for auras, not for pain) and sodium valproate. In addition, there are experimental drugs for auras, but there is not yet enough data on these.
Summary
Migraine aura without headache is a form of migraine where neurological aura symptoms occur without a pain phase. Often, it is a matter of the natural development of migraine with age, but the matter should always be verified by a neurologist.
Markku Nissilä, specialist in neurology
Frequently asked questions about migraine aura without headache
How common is migraine aura without headache?
It is fairly rare, but can become more common during menopause and in connection with a long history of migraine.
How is it distinguished from a TIA?
A TIA often starts abruptly without the typical progression of an aura. In a migraine aura, symptoms usually develop gradually and last about 20–60 minutes.
Can a painless aura be dangerous?
Usually not, but if the symptoms differ from previous ones or last over an hour, it is worth seeking a neurological examination.
Is there medication for it?
There is no actual targeted medication, but preventive medication such as candesartan or lamotrigine can reduce the occurrence of auras.
Is a painless aura a sign of migraine easing?
In some cases, yes. After a long history of migraine, the emergence of auras without pain may anticipate the fading of migraine.
Read more and find natural help
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