What Is Acephalgic (or Silent) Migraine?

A migraine is still a migraine, even without the headache.

Migraines don’t always come with a headache.
Migraines don’t always come with a headache.. IAN HOOTON/Getty Images

"Acephalgic migraine" or "silent migraine" means a migraine that occurs without an actual headache. Any type of migraine — regardless of whether you have an aura with it or not — can be an acephalgic migraine.

This may sound odd — how can you have a migraine without the pounding head pain? But using the term "migraine" to describe only the actual headache isn't accurate, since the neurological disorder encompasses many more symptoms than just that head pain.

Therefore, an acephalgic migraine or silent migraine is just as much a migraine as an episode that actually includes intense head pain. Here's some more information on this type of migraine.

Acephalgic Migraine Skips the Headache Phase

As you probably know if you suffer from migraines, there are four phases of a migraine attack (for a more detailed description of the four phases, see Anatomy of a Migraine). These phases include:

  1. Prodrome (or pre-headache) phase, which can start several hours or in some cases days before the actual migraine hits. The prodrome phase is characterized by numerous symptoms that can range from depression to diarrhea — think of it like a warning light for your coming migraine.
  2. Aura phase. When most people think "migraine," they often think "aura," which is the term for the visual disturbances that precede the head pain in a migraine attack.
  3. Headache phase. When you suffer from head pain during a migraine attack, it can be severely debilitating. This pain often comes in concert with increased sensitivity to light, sound and odors, plus a variety of other symptoms that can leave a migraineur bed-ridden.
  1. Postdrome (post-headache) phase, which (like the prodrome phase) can last for hours or days following the headache phase. This can include euphoria or depression, weakness and poor concentration.

As I said above, an acephalgic migraine skips number 3 on this list, the headache phase. But don't assume that since you don't get the head pain most often associated with a migraine that your condition doesn't involve true migraine disorder.

Diagnosis of Acephalgic Migraine Tricky

Anyone — adult or child — can experience an acephalgic migraine. It's possible for only some of your migraine attacks to involve acephalgic migraine. Alternatively, all of your migraine attacks could exclude the actual headache.

In one study of acephalgic migraine, the most common symptom was the classic half-moon visual disturbance. People also experienced vision loss in half of one eye (another common migraine symptom), other vision problems, and alterations in color perception.

It can be tricky to diagnose migraine when the person in question doesn't get a headache, and in some cases people have mistakenly been diagnosed with epilepsy, based on the neurological symptoms present in the attacks. It's also possible to misdiagnose an acephalgic migraine as a stroke.

Specialists in this type of migraine say acephalgic migraine should be considered as a possible cause whenever there's an "acute episodic neurologic disorder," regardless of whether it includes headache symptoms.

Middle-Age and Acephalgic Migraine

Several studies have documented that people over the age of 50 are more likely to have symptoms of acephalgic migraine.

For example, in one large study about one person in every 100 reported suffering "visual migrainous symptoms" that lasted up to an hour, but without leading to an actual migraine. In the majority of people, these attacks were not accompanied by headaches at all, and 42% of those reporting these symptoms had no medical history of headaches.

The researchers looked into whether these symptoms were associated with an increased risk of stroke, and concluded they were not. In fact, they concluded that the symptoms didn't warrant intense investigation, since in the vast majority of cases they didn't indicate a major problem.

Treatment Doesn't Differ

When you have migraine disorder, it doesn't matter if you have acephalgic migraine or whether you actually suffer from acute head pain — the treatment is the same.

So if your acephalgic migraine symptoms are impacting your life (they do in some cases), or if only some of your migraine attacks involve an acephalgic migraine, you should talk to your doctor about migraine treatment.

Sources:

Fisher CM. Late-life migraine accompaniments--further experience. Stroke. 1986 Sep-Oct;17(5):1033-42.

Freedom T et al. Migraine with and without headache. Seminars in Ophthalmology. 2003 Dec;18(4):210-7.

Martins IP et al. Late onset and early onset aura: the same disorder. The Journal of Headache and Pain. 2012 Apr; 13(3): 243–245.

O'Connor PS et al. Acephalgic migraine. Fifteen years experience. Ophthalmology. 1981 Oct;88(10):999-1003.

Wijman CA et al. Migrainous Visual Accompaniments Are Not Rare in Late Life: The Framingham Study. Stroke. 1998 Aug;29(8):1539-43.

Continue Reading