These Are the Signs You’re Having a Silent Migraine—and How to Treat It

Updated: Apr. 29, 2021

When symptoms of a migraine creep up but you don't have the telltale head pain, you may be confused. Here's how to figure out what's going on.

What is a migraine?

Before diving into silent migraines, it’s important to know about what a migraine is—a severe, often one-sided, headache that pulsates or throbs. They often last two to four hours, and people typically also experience sensitivity to light, sound, and motion. Some people might deal with nausea or vomiting, too, along with these things migraines hurt besides your head.

What is a silent migraine?

Not every migraine is obvious. In fact, there are some surprising signs of an impending attack. And while a “silent migraine” isn’t an official medical term, patients sometimes use it to describe when they get a migraine aura (more on that in a minute) but don’t suffer from the accompanying head pain, explains John Rothrock, MD, a professor of neurology at the George Washington University School of Medicine & Health Sciences in Washington, DC.

It may also indicate a missing migraine

Because it’s not an official diagnosis, a silent migraine can have multiple meanings. Someone may get that “I’m going to get a migraine” feeling (called a prodrome), but the aura or headache never shows up, adds Dr. Rothrock. “That day you might feel foggy, your coordination may be off, or you may feel uneasy.” Find out if you have one of these eight types of headaches.

Sad mother showing headache while sitting at home. She is looking very tired. Focus on womanOlena Yakobchuk/Shutterstock

Understanding a migraine aura

About one-quarter of migraine sufferers experience an aura—a visual, sensory, or speech disturbance—before their migraine. You may see spots, lights, or zigzags, feel numbness or tingling in one arm, or have trouble speaking, notes the American Migraine Foundation. About a half-hour later, the traditional unilateral head pain known as a migraine typically hits.

The bright side: it’s usually temporary

It’s a relief to know that auras are only temporary and the symptoms disappear within an hour. Very rarely though, some people may suffer from continuous auras. That may mean you have them throughout the day or they stick around longer than the norm, explains John Wall, MD, a clinical neurology professor at the University of Arizona in Tucson, Arizona. If you experience other symptoms such as weakness, vision loss, or numbness, these are some signs your headache could be something worse and may require going to the doctor more urgently.

Migraines don’t keep the status quo

One reason migraines can be so perplexing to treat is that they differ so much from patient to patient. And they can even evolve. “Migraines are all over the board. No two are alike, even within the same person; migraines change throughout their life,” says Dr. Rothrock.

The aftermath

Just because your migraine is over doesn’t mean you have total relief. Following a migraine, you may also have what are called postdrome symptoms. “The day after a migraine, while you may not have much of a headache, you may feel hungover, washed out, or can’t think as sharp,” explains Dr. Rothrock. This phase may be another facet of a “silent migraine.”

Woman hand with pills medicine tablets and glass of water Solomiya Malovana/Shutterstock

How to treat a silent migraine

How often do they appear? How much do they affect your quality of life? “If they’re infrequent, short, and non-disabling, I wouldn’t treat the aura itself,” says Dr. Wall. If they are persistent, you may benefit from preventative migraine drugs, but they won’t help everyone, he says. He adds that in some instances, off-label use of anti-epileptic medications may work because they stabilize the function of brain cells.

Have a plan in place

The first time you have an aura can be frightening—you have no clue what’s going on. If you get auras with or without headaches or “have a feeling” one is coming on, you should have a treatment plan in place with your doctor, says Dr. Wall. Having your medications (OTC or Rx’s) readily available is the best be-ready strategy, he says. You can also check out the best CBD hemp oils for migraines for an alternative treatment.

Skip the eye doctor

It would be understandable if you may make an appointment with your eye doctor if you see spots, flashes, or sparkles, says Dr. Wall. It feels like a visual problem. But in this case, your eye doctor won’t be of much help, he says. You need a headache specialist to step in. These are the surprising problems eye doctors can spot first.

Get the right care

Only half of migraine sufferers get an actual diagnosis, and only half of those are prescribed treatment by their physician, Dr. Wall points out. Your primary care physician is a great person to start with, but you’ll probably need to see a headache specialist. “It’s a lot to ask a PCP to care for a disorder that’s always changing and has so many manifestations,” says Dr. Rothrock. A headache clinic, a neurologist specializing in headache management, or even a general neurologist can help. One resource is the National Headache Foundation, which lists providers who are members of the foundation. The American Migraine Foundation also has a search function to find a qualified headache specialist.