What is a Migraine Without Aura?

Back to the Basics in a Question and Answer Format

Am I Having a Migraine?. Cultura RM/Keth Clouston/Getty Images

You may be surprised to know that migraines without auras are the most common type of migraine. Additionally, migraines without auras occur more frequently and are usually more disabling than migraines with aura.

Let's review the basics on migraines without auras in a question and answer style format.

What is a Migraine Without Aura?

According to the third edition of the International Classification of Headache Disorders (2013), an individual must have at least five attacks meeting the following criteria:

  • Headache attacks last 4-72 hours
  • Headache has at least 2 of the following characteristics:
    • Pain is unilateral (one-sided)
    • Pain is a throbbing sensation -- rapid beating or pulsation
    • Pain is of moderate to severe intensity
    • Migraine pain is worsened by regular physical activity (i.e., walking, climbing stairs)
  • During the attack, people experience at least one of the following:
  • Headache cannot be attributed to another disorder

How are Migraines Diagnosed?

While the diagnosis of a migraine without aura technically involves meeting several criteria defined by the International Headache Society, your doctor may utilize the POUND mnemonic and ID migraine questionnaire — these are faster, simpler tests that can help clinch the diagnosis more efficiently.

What are Chronic Migraines?

Chronic migraines occur on 15 days per month or more.

What Causes Migraines?

Scientists used to believe that migraines were caused by dilatation of blood vessels in the brain. Now, they believe that nerves within the brain and spinal cord play a vital role, releasing molecules like nitric oxide and calcitonin gene-related peptide (CGRP), which trigger migraine pain. As the migraine attacks progress, the brainstem and spinal cord become sensitized.

This leads to a vicious cycle of head pain and an increased sensitivity to one's environment.

How are Migraines Prevented?

Typical migraine preventive medications include:

  • Antihypertensives (blood pressure lowering agents): metoprolol, propranolol, timolol
  • Antidepressants: amitriptyline (Elavil) and venlafaxine (Effexor)
  • Anticonvulsants: valproate products, divalproex sodium and sodium valproate, topiramate (Topamax)
  • Petasites (Butterbur)

How are Migraines Treated?

Typical treatments for an acute migraine include:

  • Non-steroidal anti-inflammatories (NSAIDs): ibuprofen or naproxen sodium (Aleve)
  • Triptans: Sumatriptan (Imitrex)
  • Anti-nausea medications: intravenous (IV) metoclopramide (Reglan)
  • Dihydroergotamines: (D.H.E. 45, Migranal)
  • Dexamethasone
  • Intranasal Lidocaine

Did You Know These Interesting Facts About Migraines Without Auras?

  • People who suffer from migraines without auras are more likely than those who suffer from other headache disorders to develop a medication-overuse headache.
  • Migraines without auras commonly have a relationship to a woman's menstrual cycle.  According to the American Headache Society, 35-51% of females with migraines have menstrually related migraines.

    Take Home Message

    Migraine without aura is a complicated and debilitating neurological disorder. If you think you suffer from migraines, please be sure to see a doctor for a proper diagnosis and treatment plan. Remain steadfast in your persistent quest to remain headache free.


    Durham PL. Calcitonin Gene-Related Peptide (CGRP) and Migraine. Headache. 2006;46(Suppl 1):S3-S8.

    Ebell MH. Diagnosis of a migraine headache. Am Fam Physician. 2006;74(12):2087–2088.

    Gilmore B, & Michael M. Treatment of Acute Migraine Headache. Am Fam Physician. 2011 Feb 1;83(3):271-280.

    Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders: 3rd Edition (beta version)". Cephalalgia 2013;33(9):629-808.

    Menstrual Migraines: New Approaches to Diagnosis and Treatment. (n.d.). In American Headache Society. Retrieved May 2nd, 2015, from www.americanheadachesociety.org/assets/1/7/Vincent_Martin_-_Menstrual_Martin.pdf.

    Olesen J, & Jansen-Olesen I. Nitric oxide mechanisms in migraine. Pathol Biol (Paris). 2000 Sep;48(7):648-57.

    Lipton RB, Dodick D, Sadovsky R, Kolodner K, & Endicott J, Hettiarachchi J, Harrison W. A self-administered screener for migraine in primary care: The ID Migraine validation study. Neurology. 2003 Aug 12;61(3):375-82.

    Silberstein SD, et al. Evidence-based guideline update: pharmacologic treatment for episodic migraine prevention in adults: report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology 2012; 78:1337.

    DISCLAIMER: The information in this site is for informational purposes only. It should not be used as a substitute for personal care by a licensed physician. Please see your doctor for advice, diagnosis, and treatment of any concerning symptoms or medical condition.

    Continue Reading