Acephalgic (Silent) Migraine

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Acephalgic migraine is an old name for migraine aura without head pain. It is also known as silent migraine. It is more common in women than in men.1

The 4 phases of migraine

There are 4 phases of a migraine attack, but not everyone experiences all 4 phases. The 4 phases of migraine are:

What is an acephalgic migraine?

An acephalgic migraine skips the head pain of phase 3. Some people always have migraine aura with no head pain. However, some people who normally have migraine aura with pain will sometimes have a silent migraine, or no head pain.

Other names for acephalgic migraine include:

  • Migraine aura without head pain
  • Typical aura without headache
  • Silent migraine
  • Migraine equivalent
  • Migraine variant

Symptoms of acephalgic migraine

As with other migraines with aura, vision changes are the most common symptom of a silent, or acephalgic migraine. Symptoms build over 5 to 20 minutes and last about 1 hour. However, other aura symptoms also occur, including:1

  • Tingling or numbness that moves from 1 part of the body to another
  • Odd or prickly feelings, or numbness in the hand, arm, face, or tongue
  • Odd feelings in the whole body
  • Vertigo
  • Amnesia or confusion
  • Trouble speaking
  • Hiccups
  • Loss of hearing
  • Droopy eyelid
  • Fainting

Diagnosing acephalgic (silent) migraine

Acephalgic migraine aura can be hard to diagnose. This type of migraine is diagnosed after other possible causes of the symptoms have been ruled out. It can be confused with stroke or seizures. The best tool to diagnose acephalgic migraine is your migraine diary.1

Treatment of acephalgic migraine

It can be hard to treat acephalgic migraine. Symptoms often go away faster than drugs, such as triptans and NSAIDs, work. However, some people find that their other migraine symptoms like nausea and sensitivity to light get better with treatment. There are no FDA-approved drugs specifically for acephalgic or silent migraine.1,2

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