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What are silent migraines?

Silent migraines are also known as migraine without headache, when a person has all the symptoms of a migraine, but not the headache. These migraine symptoms can include the aura warning signs before the migraine comes on.

To understand silent migraine, it helps to know the four distinct phases of migraines.

  • Premonitory phase or prodrome. This phase warns that a migraine is coming. Symptoms include changes in your mental state, such as irritability or confusion, and physical signs such as thirst or diarrhoea. About one out of every four migraine sufferers experiences premonitory symptoms as early as 24 hours before the migraine pain attacks. 
  • Aura. The phenomenon called aura is best known for its unusual visual symptoms. But other sensory, motor and language disturbances can occur. About one in four migraine sufferers experiences aura. Aura is a phase that typically lasts about up to an hour.
  • Pain. Migraine pain itself is often on one side of the head. It’s often a throbbing pain and may be accompanied by nausea, vomiting and extreme sensitivity to light and sound. The pain phase can last from several to 72 hours. 
  • Resolution. After a migraine, many people experience deep fatigue and general malaise for up to 24 hours.

Not all migraines follow this pattern. There are migraines with and without aura. There are also migraines with and without pain. Even within the same person, migraines are extremely unpredictable.

Silent migraine symptoms

The symptoms of silent migraine include any of the typical signs and symptoms of a migraine, but without the pain.

Physical symptoms include:

  • Diarrhoea
  • Nausea
  • Vomiting
  • Food cravings
  • Loss of appetite
  • Thirst
  • Increased urination
  • Chills
  • Fatigue.

Emotional and mental symptoms include:

  • Confusion
  • Irritability
  • Euphoria.

Aura symptoms include:

  • Wavy or jagged lines
  • Flashing lights
  • Dots or spots in your vision
  • Blind spots
  • Tunnel vision
  • Disruptions in hearing
  • Auditory hallucinations
  • Distortions in smell or taste
  • Numbness, a pins-and-needles feeling, or other unusual body sensations
  • Difficulty remembering or saying a word
  • Other language difficulties.

The American Migraine Study in 1999 involved 30,000 people with migraines. Nine out of every 10 said they couldn't work or function normally when they had migraines. More than half said they experienced symptoms severe enough to need bed rest. Even without the pain of migraine, the other symptoms can be temporarily disturbing. They can disrupt your normal day.

What causes silent migraines?

Researchers are now looking at migraine aura and pain as two distinct mechanisms. Doing so is leading to a better understanding of silent migraine.

In the past, experts thought migraines were primarily a problem with blood flow in the brain. That is they thought of them as "vascular" events. They now believe aura is a "neurovascular" event. That means it involves the way nerve cells are firing in the brain and how nerve cell activity relates to the brain's blood flow. Aura appears to be a case of overstimulation and then depression of nerve cell activity in the brain.

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