Not all forms of migraine come with headache. Migraine aura without headache, previously known as ‘acephalgic migraine’, and sometimes called ‘silent’ migraine, is exactly what it sounds like – when someone has an attack consisting of migraine aura without any head pain.
The definition of an aura is a recurrent attack that features temporary visual, sensory and/or speech/language symptoms. These symptoms include:
- blurry vision
- light sensitivity
- vision loss
- seeing zigzags or squiggly lines
- difficulty speaking
- abdominal pain
Typical aura without headache, despite a lack of head pain, can still be disabling for those who live with it. The more serious migraine subtypes – brainstem, hemiplegic, vestibular, abdominal, and retinal migraine – can also occur without headache.
Treating typical aura without headache can be difficult, as there aren’t really any treatments for aura. Many medications like triptans usually take longer to work than aura’s duration, so most people don’t take any as-needed medication. Others, however, may find that associated symptoms like nausea and sensitivity to light and sound will improve if treated.
Some small studies and case reports suggest the use of magnesium and aspirin, or for people with prolonged aura, there have been some treatment attempts with intranasal ketamine. These, however, are very small studies, and this is very much an off-label use. There are few specific studies looking at CGRP and aura, but anecdotally many have found the CGRP preventatives prevent the entire attack, including aura, so may be a worthwhile consideration.