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 this is referred to as "painless migraine," but this is a separate topic and will be covered in a future blog post.
Symptoms and prevalence
Symptoms of migraine aura can include:
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Visual field disturbances, such as flickering lights, zigzag patterns, or blind spots.
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Sensory disturbances, tingling, or numbness in the upper limbs and face.
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Balance disturbances, dizziness, and feelings of confusion.
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Difficulty with speech production.
Migraine aura without headache is rare. However, it is part of the natural course of migraine, especially in women, for migraine auras manifesting as visual disturbances to appear during menopause, even if migraine auras had not occurred previously. The connection between aura and the headache phase usually disappears quickly, and auras may even occur several times a day. The appearance of auras in the context of a long history of migraine is a phenomenon that predicts the cessation of migraine.
Identification and differential diagnosis
Migraine aura without headache can be more difficult to identify because the headache is absent, and the symptom picture can 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 new or different from before. If an aura begins directly with numbness without visual disturbance, prompt investigation is needed. Sometimes the appearance of auras coincides with an increase in blood pressure.
Treatment and monitoring
Triptans (specific migraine medications) are not effective in treating migraine auras, but they are also not dangerous. If the aura lasts for a typical duration, i.e., about 20 minutes, orally administered medications are practically insignificant. For long auras, lasting more than half an hour, treatment with acetazolamide, which is currently a special permission medication, may be considered on a case-by-case basis. The aura should not last for more than an hour. If auras occur inconveniently often, they should be treated with regular prophylactic medication, such as candesartan. Other options include lamotrigine (which only works for auras, not 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 the pain phase. Often, this is part of the natural progression of migraine with age, but it should always be confirmed 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 relatively rare but can become more common during menopause and in conjunction with a long history of migraine.
How is it distinguished from a TIA?
A TIA often begins suddenly without the typical progression of an aura. In migraine aura, symptoms usually develop gradually and last about 20–60 minutes.
Can a painless aura be dangerous?
Generally not, but if the symptoms differ from previous ones or last longer than an hour, it is advisable to seek examination by a neurologist.
Is there medication for it?
There is no specific abortive medication, but prophylactic medication such as candesartan or lamotrigine can reduce the occurrence of auras.
Is a painless aura a sign that the migraine is getting better?
In some cases, yes. After a long history of migraine, the appearance of auras without pain can indicate the fading of migraine.
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