What Is a Silent Migraine? Migraine Without the Headache

A silent migraine is a migraine aura without the headache. Vision changes such as a shimmering zigzag line or a blind spot build over several minutes and usually fade within an hour, and no headache follows. Doctors call it typical aura without headache. Because a first episode can look like a stroke warning, it needs a medical evaluation before anything else.

What a silent migraine looks like

Visual aura is the most common kind. It occurs in over 90 percent of people who have migraine with aura, at least in some attacks. It often starts as a flickering zigzag near the center of your vision that slowly spreads to one side, leaving a blurry or blank patch behind it. Some people see dots, sparks or flashing lights. Others feel tingling or numbness, or have trouble finding words.

Under the international headache criteria, each aura symptom lasts 5 to 60 minutes, and symptoms tend to develop gradually, often one after another. They go away completely. In a silent migraine, no headache comes with the aura or within 60 minutes after it.

Why it still counts as migraine

It can seem strange to call it migraine when nothing hurts. But many people with migraine have a mix: some auras followed by a full headache, some by a milder headache, and some by no headache at all. Some people only ever have the aura. The National Institute of Neurological Disorders and Stroke also notes that some migraine episodes come without headache, with vision problems or symptoms such as nausea instead.

Silent migraine or stroke warning?

A transient ischemic attack, often called a mini stroke, can also cause brief vision loss, numbness or trouble speaking. The CDC notes that because these attacks clear up, many people ignore them, even though a TIA is a sign of a serious condition.

There are differences. Aura usually builds and spreads over minutes, and it often starts with something added, like flashing or shimmering. Stroke symptoms come on suddenly and usually take something away: sight, strength, feeling or speech.

Still, you cannot safely tell them apart on your own, especially the first time. Without the headache, the international criteria note that diagnosis is harder and often needs testing. They advise ruling out a TIA when aura starts for the first time after age 40, when symptoms only take something away, such as losing half of your vision, or when an aura is unusually long or very short.

For a first episode, or any change in your usual aura, see your primary care doctor or a neurologist promptly. Call 9-1-1 for sudden numbness or weakness in the face, arm or leg, especially on one side; sudden confusion or trouble speaking; sudden trouble seeing; sudden trouble walking, dizziness or loss of balance; or a sudden severe headache with no known cause. Note the time the symptoms started.

What the research says about acupuncture

For migraine prevention, the National Center for Complementary and Integrative Health reports moderate-quality evidence that acupuncture may reduce how often migraines happen, based on a 2016 review of 22 studies with almost 5,000 people. It may be better than sham acupuncture, but the difference is small.

Those studies measured how often migraines happened. I have not found trials of acupuncture for aura without headache, so I cannot tell you it prevents silent migraines. What the research supports is a careful trial for migraine prevention, alongside your medical care.

Where my care fits

Your physician or neurologist confirms the diagnosis and leads medical care. The first visit runs 60 to 75 minutes. I review your headache pattern and check the neck and jaw muscles, since many people with migraine also have neck tension or clench. Treatment uses acupuncture for migraine prevention, including neuro-functional acupuncture, built on neuroscience and evidence-based practice. Unlike regular electroacupuncture, the needles and gentle electrical stimulation are mapped to the specific nerves involved, such as the nerves of the head and neck. It works in three ways. It neurorehabilitates, helping irritated tissues and nerve receptors recover. It neuromodulates, shifting the body's own pain-relieving chemistry. It neuroregulates, calming the nerve signals and circuits involved in migraine. A diary tracks how often auras and headaches happen. The headaches and migraines page covers the full plan. Results vary from person to person.

For head and face pain beyond migraine, the head pain page has more.