You Can Have a Migraine Without a Headache

For most people, a migraine is a very painful experience. More intense than a headache, a migraine can cause throbbing and pounding so severe that some sufferers are incapacitated. But for a small percentage of migraine sufferers, usually those in midlife or older, the pain never comes. Instead, they experience the visual disturbances that often precede a migraine, minus the discomfort. What exactly is happening, and why is it problematic?

Migraine and Aura

First of all, itís helpful to understand the typical migraine experience. About 15 to 20 percent of migraine sufferers experience migraine with aura: Roughly 15 minutes to an hour before a headache begins, these patients may develop blurry vision, see zigzag lines or spots of light, or experience partial vision loss. These visual disturbances are known as aura. Aura also may take the form of sensory disturbances such as tingling or numbness in parts of the body. Once the aura passes, the debilitating headache begins.

For a small percentage of people, aura may occur without a headache, which can be disorienting. "If you get an aura and then you get a headache, then itís pretty clear itís migraine," says Richard B. Lipton, MD, director of the Montefiore Headache Center at the Albert Einstein College of Medicine in New York City. "If you get an aura and you donít get a headache, that can be pretty scary." To rule out stroke or vision problems, a doctor will take a thorough medical history, conduct an eye exam, and may want to order an MRI (magnetic resonance imaging, a technique that uses magnets and radio waves to produce images) of the brain. Even so, migraine without headache can be tricky to diagnose. A couple of clues that what youíre experiencing might be migraine-related and not something more sinister are that youíve had a traditional migraine in the past, and you have a family history of migraine.

Another way to determine if what youíre experiencing is migraine-related is to try traditional migraine therapies such as tricyclic antidepressants and antiepileptic drugs. "If a person [who has aura but no headache] responds to migraine therapy, thatís really very comforting," says Lipton.

Many people who experience aura without headache do so only occasionally, in which case they may choose not to pursue any kind of treatment (although they should have a diagnostic evaluation in order to rule out serious conditions). However, people for whom even occasional aura may be troublesome or dangerousóprofessional drivers or surgeons, for exampleómight need to rely on medication. But here's some good news: Itís even possible to head off episodes of aura by paying attention to common triggers, such as stress, caffeine, and certain additives in food.

Itís Not All in Your Head

Interestingly, certain types of migraines donít involve the head at all but rather the abdomen. Abdominal migraine occurs mainly in children ages five to nine, but it can strike anybody. The primary symptoms are moderate to severe abdominal pain, nausea, and vomiting that last anywhere from an hour to three days. Because these symptoms can be caused by so many other conditions, doctors generally diagnose it when family members have a history of migraine and when other gastrointestinal conditions are ruled out. People who have this disorder in childhood are at higher risk of developing typical migraines with headaches when theyíre older. Abdominal migraine can be debilitating, and traditional migraine medicines are often prescribed. They include preventive drugs such as beta blockers or tricyclic antidepressants and acute treatments such as anti-nausea drugs, and triptans (medications used to treat headaches).

Another abdominal condition, known as cyclic vomiting, has been found to be related to migraine as well. Like abdominal migraine, cyclic vomiting typically strikes children. This syndrome causes sufferers to endure regular, fairly predictable bouts of intense vomiting along with abdominal pain, sometimes for several days. As with abdominal migraine, this diagnosis is one of exclusionóand like children with abdominal migraine, sufferers often have a family history of migraine and grow up to become migraine sufferers as well. Anti-migraine drugs may provide some relief.

Richard B. Lipton, MD, reviewed this article on March 30, 2016.

Sources

Lipton, Richard B., MD. Phone conversation and email correspondence with author. March 24, 2016.

"Migraine and Aura." American Migraine Foundation. Last updated August 26, 2013.

"Abdominal Migraineóthe Basics." American Migraine Foundation. Last updated June 1, 2012.

"Children Get Headaches Too!" American Migraine Foundation. Accessed on March 30, 2016.

"Visual Migraine." Brigham and Womenís Hospital. Last updated March 11, 2016.

"Cyclic Vomiting Syndrome." Genetics Home Reference. Last reviewed March 2014.

"Migraine Headaches." Cleveland Clinic. Last reviewed December 29, 2014.