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What Causes Migraine Aura Without Pain

Can I Have A Visual Migraine Without A Headache

Visual migraine aura with or without headache – Video abstract: 30999

Definitely. It is actually very common to have a visual migraine without any headache. The medical term for this is acephalgic migraine, which literally means migraine symptoms without headache. Except for the absence of a headache, the visual symptoms in acephalgic migraine are identical to the episodes that accompany a classic migraine aura.

Can They Lead To Death

Aura itself cannot kill someone. However, it can be life threatening if it causes someone to have an accident, especially while driving, cooking, or operating machinery. Stroke and some autoimmune conditions that can be fatal can cause persistent, unexplained aura not associated with migraine.

Aura without migraine can also be a sign of permanent vision problems or visual field defects.

To distinguish aura from other visual disturbances, the AMF recommends covering one eye and trying to look at or read something, then covering the other eye and repeating the task. True aura will cause the same or similar vision problems in both eyes.

Migraine Without Aura And Migraine With Aura: Separate Entities

Whether MA and MWA are part of a continuum or distinct entities has been much disputed . The continuum theory is based on the clinical co-occurrence of MA and MWA, the similarity between MA and MWA during the prodrome, the headache and the resolution phases and the similar therapeutic response. Clinical observations also suggest that one form may transform into the other . However, clinical, epidemiological, pathophysiological and genetic findings suggest that MA and MWA are distinct . The co-occurrence of MA and MWA is no more than a random occurrence . Moreover, headaches in MA are less severe and shorter than in MWA and in MWA a hormonal influence is clearer . In a population-based twin sample it was found that unilateral headache, photophobia and a shorter duration were associated with MA whilst nausea was more common in MWA .

Dilatation of large inter- and extracranial arteries occurs in both forms during an attack, but regional cerebral blood flow changes are present only in MA . Finally imaging and biochemical studies suggest that these are two distinct entities .

Angus A. Wilfong MD, James Owens MD, PhD, in, 2010

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What Is Migraine Aura Without Pain

Migraine aura without pain includes changes in vision or changes in the other senses and speech but no head pain. Symptoms gradually build over 5 to 20 minutes and then go away after about 1 hour. The lack of head pain sets it apart from other types of migraine with aura. Also, no other disorder can be found to be blamed for the symptoms.1

The Rare Type Of Migraine


Its relatively common for migraine sufferers to experience an aura an hour or so before their head pain starts, and nearly all of the time its the type of visual disturbance described above, says headache specialist Nada Hindiyeh, MD, of Stanford University. But these two phases dont always occur in every migraine episode.

Various studies have found that people who have migraine with aura experience an aura with no subsequent headache between 37% and 44% of the time. Among people with no history of migraine, its estimated that about 13% have experienced aura alone. This can happen to anyone of any age, but it does seem to happen more often among people over age 50, primarily in those with a history of migraine with aura in their younger years but also, to a lesser extent, in some people who never had this type of head pain. Because it seemed as though only the eyes were affected, these events used to be called ocular migraines, but Dr. Hindiyeh says thats a misnomer because the aura still originates within the brain, not within the eyes.

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Symptoms Of Migraine With Brainstem Aura

With this kind of migraine, youll likely experience many of the common symptoms of classic migraine with aura, such as:

  • seeing lights flashing in your vision
  • seeing spots, stars, or lines in your vision
  • losing full vision or seeing static
  • feeling numb in your face, hands, or head
  • feeling abnormally weak or exhausted

Because this type of migraine starts in your brainstem, you may have symptoms on one side or both sides of your body. Symptoms that are specific to an MBA may include:

  • feeling nauseous
  • feeling as though your surroundings are spinning, to the point where you may not be able to stand up straight
  • having double vision
  • feeling confused or disoriented
  • not being able to speak or pronounce words properly
  • changes in your ability to hear
  • having an extremely painful headache
  • not being able to control your muscles
  • blacking out and losing consciousness

If you have one or more of these symptoms, speak with your doctor as soon as possible for a diagnosis and to rule out any more serious causes.

How Prevalent Are Migraines

Migraines are about three times more common in women than men, and may affect more than 12 percent of the U.S. adult population. Migraines often run in families, and can start as early as elementary school but most often in early adulthood. They often fade away later in life, but can strike at any time. The most common cause of recurring, disabling headache pain, migraines are also the most common underlying cause of disabling chronic, daily headache pain. While migraines are the No. 1 reason that patients see a neurologist, most cases are handled by primary care physicians.

Things that can make the headaches more likely to occur include:

  • Alcohol

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What Causes A Migraine

Although migraines are extremely common, their exact cause remains unknown. It appears likely that the visual aura relates to a phenomenon called cortical spreading depression which temporarily affects electrical impulses in the brain. The pain of a migraine headache probably relates to spasm or irritability of blood vessels in the brain, which are sensitive to pain . Beyond these hypotheses, however, the exact mechanism that triggers a migraine remains unknown.

It is often possible to identify certain risk factors that increase the chance of having migraines. A positive family history is very common, so the doctor will often ask about headaches in ones parents or siblings. Overall, migraines are more common in women than in men. In addition, a persons hormonal status can affect the pattern of migraines they experience therefore, it is natural for a woman to notice a change in headaches and other migraine symptoms in adolescence or around the time of menopause.

Many individuals can identify specific triggers for their migraines. These triggers include fatigue, skipping a meal, caffeine withdrawal, stress, and certain foods . For many patients with isolated visual migraines, however, the events can be very infrequent and no definite trigger can be determined.

Are They Treated Differently

Lean About Migraine Aura

Not really. Experts aren’t sure what causes auras, so there’s nothing special you can do about them. It’s about treating the migraine symptoms and preventing more attacks.

To ease migraine symptoms:

  • Stay in a quiet, dark room.
  • Put cold compresses or pressure on the painful areas.
  • Take pain-relieving medications such as aspirin, acetaminophen, ibuprofen, ketorolac, or naproxen. People under the age of 19 should not take aspirin.
  • Use prescription drugs, such as almotriptan , eletriptan , frovatriptan , lasmiditan , naratriptan , rizatriptan , and sumatriptan , which help narrow blood vessels.
  • Ergots and gepants may also ease migraine pain.
  • Use medications to treat other migraine symptoms such as nausea and vomiting.

To prevent migraines:

Medications. If other treatments donât work and you have 4 or more migraine days a month, your doctor may suggest preventive medicines. You take these regularly to make headaches less severe or less frequent. They include seizure medicines, blood pressure medicines , and some antidepressants. CGRP inhibitors are a new class of preventive medicine that your doctor may recommend if other medicines donât help.

Keep a headache diary. It will help you spot things that might trigger your migraines. Diary entries should include things like the date and time of your headache, any foods you had eaten, what you did, and medication you took just before the headache began. It may take 6 to 8 weeks or longer to begin to see patterns and triggers.

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Migraine With Aura Symptoms

Migraines with aura include additional visual and non-visual symptoms that can provide a useful warning that a headache is on its way.1

The visual aura symptoms may include:1,2

  • Geometric patterns
  • Sparkles
  • A shimmering effect

These may appear in the center of your field of vision and gradually spread outward.1,2 Some people also experience blind spots or tunnel vision.

Non-visual aura symptoms may include:1,2

  • Tingling or numbness in the hands or face
  • Dizziness or vertigo
  • Difficulty with speech and/or hearing
  • A sense of fear or confusion
  • Partial paralysis or fainting

Auras usually develop over the course of five to 20 minutes and last fewer than 60 minutes. The head pain and other symptoms associated with classic migraines typically come after the aura, but might begin during the auraas well.1

In rare cases, you may experience the aura without a migraine following this is more common in people over the age of 50.1,2

What Are The ‘red Flags’ That My Visual Symptoms Are Not Due To Migraine

The typical symptoms of a visual migraine are positive, meaning that there is something shimmering or sparkling that is disrupting the vision. Migraines are less likely to cause “negative” symptoms of pure visual darkness. An episode of visual darkness typically requires additional evaluation for other conditions, including a mini-stroke .

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From A Certain Point Of View

Not everyone is as enthusiastic as Dalkara about the assertion that aura causes the pain of migraine headaches. For some researchers, the variability of auras, and their occurrence with and without headache, counts against the theory. There is very limited evidence in humans that aura is actually whats causing the pain, Charles says. Its neither necessary nor sufficient for headache.

Dalkara theorizes that the inconsistent relationship between aura and headache might be in part due to variation in the intensity and propagation of CSD events. Stronger CSDs could first generate an aura, then initiate an inflammatory cascade leading to headache, whereas weaker CSDs might cause neurological symptoms, but be too insubstantial to activate inflammatory signalling which would explain auras without a headache.

As for headaches that arise without aura, Dalkara points to a 2018 study in mice in which he showed that both sleep deprivation and depletion of the brains energy stores can also initiate the inflammatory cascades seen in migraine. This suggests that there are multiple routes to migraine headache CSD might cause pain, but perhaps not exclusively.

A Richer View Of Aura


Drawings of the strange visual phenomena seen by people who experience auras are helping scientists to understand the condition.Credit: Priya Rama

In 2012, neurologist Andrew Charles received a phone call from a septuagenarian engineer who had begun having migraines with aura at the age of 14. The man, who asked to be identified as P.V., told Charles that for the previous 18 years he had been drawing every single aura he had experienced an average of 80 per year.

Whenever he sensed an aura beginning, P.V. grabbed a sheet of paper and sketched what he saw. With an engineers meticulousness, he ran a stopwatch and redrew the shifting mirage every minute until it ended, typically 2530 minutes later. He asked Charles whether his drawings might be useful to scientists interested in migraine. Soon after, P.V. arrived in Charless office at the David Geffen School of Medicine at the University of California, Los Angeles, and deposited a thousand-strong stack of papers on the desk.

P.V.s auras began as a small focal disturbance, which then expanded into a slowly spreading, crescent-like shape. The leading edge of this crescent was a flickering, morphing band of zigzagging, multicoloured lines known as a fortification spectrum. In the spectrums wake was an area of diminished vision called a scotoma.

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What Is The Best Way To Treat Migraine With Aura

When aura symptoms begin, it can be helpful to move into a quiet, dark room and close your eyes.

Placing a cold compress on your forehead or the back of your neck may also help ease ensuing migraine pain.

Like other types of migraine, treating migraine with aura involves a combination of medications. These include medications for both prevention and relief of symptoms.

Preventive medications that may stop migraine attacks from occurring include:

Medications for symptom relief help decrease the severity of an oncoming migraine attack. Theyre typically taken as soon as the symptoms of an aura develop.

Examples of some of these medications are:

  • over-the-counter pain relievers like acetaminophen or ibuprofen
  • triptans, like rizatriptan and sumatriptan
  • dihydroergotamine
  • gepants like ubrogepant or rimegepant
  • ditans, like lasmiditan

Other alternative methods of treating migraine are also being investigated. These include things like biofeedback, acupuncture, and relaxation techniques.

What Causes Ocular Migraines

Theyre thought to originate in a similar way as migraine headaches, by irregular electrical activity in the brain. Genetics play a role in who experiences migraines, and theyre also more common in women. Potential triggers include certain MSG-containing foods, harsh light, stress and changes in weather.

Although the root cause is the same, it is not known why some people experience migraine pain after visual disturbances and others dont or why the same person might experience both on different occasions.

It is quite common that as women get older, they might have fewer headaches and less pain but more of these auras, Dr. Estemalik says.

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What Is An Ocular Migraine Aura

So, lets talk aura, those sensory changes that can accompany migraine . Aura most often manifests as visual disturbances, according to the Mayo Clinic4. But you could also experience different sensations, like hearing music or feeling like someone is touching you. When we’re talking about an ocular migraine, we’re only talking about the visual symptoms.

While some people experience an aura before their migraine headache strikes, an ocular migraine refers to the experience of only experiencing visual disturbanceswithout the stereotypical migraine head pain.

Unusual Types Of Migraines With Aura

Is Your Headache a Migraine Without Aura?

There are three other types of migraine with aura. These are all unique types of migraines and are different from the migraine with typical aura described above.

Migraine with brainstem aura

People with this condition have unique aura symptoms. This is because their migraine involves the brainstem . In addition to typical visual and sensory aura symptoms, people with migraine with brainstem aura can also have:

  • Double vision

Some of these medications work best when taken early. For many people, the aura phase of a migraine attack is a good time to take action.

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Causes Of Migraines With Aura

The cause of migraines with aura isnt fully understood.2 Like migraines without aura they are considered a neurovascular disorder. As nerve cell activity increases within the brain, inflammatory chemicals are released, causing swelling of the cranial blood vessels. As the blood vessels swell, they activate the surrounding pain receptors, which ultimately transmit pain signals to the brain.3

Migraines with aura seem to be triggered by many of the same things that can bring on migraine without aura, including:2

  • Bright lights
  • Hormonal changes such as during menstruation
  • Changes in altitude or air pressure
  • Issues with sleep lack of, or too much

Read more about what causes migraines.

Epidemiology And Natural History Of Chronic Migraine

Migraine with and without aura occurs in approximately 12% of the adult population of the United States.14 Epidemiological studies from other occidental populations are relatively consistent with this prevalence marker.15 Japanese populations have a somewhat lower prevalence of migraine, as do those in South-East Asia, Africa, and the Middle East.16 However, primary headache disorders are by far the most common neurological condition in the world for which medical consultation is sought.2 Despite the prevalence of primary headache disorders, they are also one of the most misdiagnosed and undermanaged medical conditions on the planet. This is likely due in part to rapidity of changes in the medical understanding of migraine, failure to define and develop newer migraine-specific therapies, and confusion over the relationship of migraine to other primary headache diagnoses.

Yair Sharav, Rafael Benoliel, in, 2008

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What Are The Acute Treatments For Migraine

An isolated visual migraine, without headache, typically does not require any acute treatment, since the visual symptoms resolve on their own fairly quickly. The first few times someone experiences a visual migraine it usually causes a lot of anxiety. Once someone has become familiar with the symptoms of a visual migraine, new episodes no longer cause the same level of anxiety.

It can be helpful to try to rest during the episode. Some patients benefit from other strategies, including eating something, having caffeine, or taking an over-the-counter medication such as acetaminophen or ibuprofen .

Patients in whom the visual symptoms are accompanied by a severe headache often benefit from additional therapies. The goal of these medications is to try to cut short the headache before it becomes too severe. Some patients find naproxen , which is a stronger anti-inflammatory medication, to be helpful. Other patients try a class of medications known as triptans.

Triptans are specially designed to work on receptors on blood vessels and brain cells in order to halt a migraine at an early stage. Although there are a number of different triptans, made by several different pharmaceutical companies, each of these is approximately equally effective. Triptans are often taken orally, but also come as injections and nasal sprays. These medicines are generally not considered safe in patients with a history of strokes, heart attacks, or other vascular diseases.


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