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What is a painless migraine?

Dr. Charisse Litchman

Medically reviewed by Dr. Charisse Litchman, MD, FAHS on August 18, 2020

Some people who experience migraine with aura can experience the aura without head pain — these are called “silent migraines”. The aura of silent migraines is the same as in migraine with aura, but there is no head pain afterward. Auras can be visual changes, such as seeing spots, wavy or zig zag lines, or flashing lights. The auras can also be other neurologic symptoms, like vertigo, vision loss, tingling or weakness of the face, arms and legs, confusion, and difficulty speaking. Some people have both migraine with aura and silent migraines.

Silent migraines can be very frightening because the symptoms resemble more serious neurologic problems, like stroke, meningitis, and seizure. The first time a silent migraine occurs you should be evaluated by a doctor, who will likely require scans such as an MRI. A person’s silent migraine symptoms are usually similar each time they occur, making them less frightening. You usually won’t need to see a doctor repeatedly about silent migraines as long as the symptoms don’t change. 

The causes of silent migraines are not well understood. Auras are thought to be due to an electrical or chemical phenomenon that begins in the back of your brain and moves over the areas of the brain controlling the various functions, and a person’s symptoms depend on which part of the brain is affected.

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Typically silent migraines are triggered by the same things that trigger regular migraines with or without aura, such as bright lights, weather changes, lack of sleep, stress, hormonal shifts, alcohol, and food triggers.

Whether or not silent migraines require treatment depends on how long they last and how much they interfere with your life. If you are frequently bothered by silent migraines, your medical provider may treat you with the same medications used to treat regular migraines. You may benefit from the natural remedies and stress reduction techniques known to help with regular migraines and tension headaches.

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