What are the Causes and Presenting Features of Silent Migraines?

Silent Migraines is a subset of migraines in which there is an aura and prodrome of a migraine but there are no headaches associated with them. A migraine disorder has four distinct phases namely aura, prodrome, headache, and resolution. Every phase has its own set of symptoms. Among all these phases of a migraine there are some symptoms which can be observed in all the phases. These symptoms include nausea, vomiting, appetite loss, chills, lethargy, increased urinary frequency, and irritability.^[1]

An individual with Silent Migraines will not experience headaches but the other symptoms experienced can be extremely debilitating. Migraine is a common problem faced by many individuals around the world. A study done in 2015 has reported around 15% of the adult population in the United States has this condition and the numbers are increasing. There are different types of migraines but the causes and treatment options for all the forms remain the same.^[2]

Coming to treatment of Silent Migraines, studies have shown that the normal treatments given for other forms of migraines work for this subset also. In some cases, greater occipital nerve blocks have shown to be quite effective in treating Silent Migraines, especially in cases where the individual has a prolonged aura. Transcranial magnetic stimulation has also shown great promise in treating migraine with aura but this condition has not been tested in cases of a Silent Migraines where there is only aura and no headache.^[2]

It has been estimated that among all people who suffer from migraines only about 4% people have Silent Migraines. This article highlights some of the potential causes and the presenting features of Silent Migraines.^[2]

The mechanism which results in individual experiencing migraine headaches remains unknown but studies point to genetic predisposition and environmental factors play a role in its development. Abnormal electrical activity in the brain which affects the working of the nerves and blood vessels is believed to be one of the causes of migraines.

Changes in the level of serotonin also play a role in individual experiencing migraines.^[3]

Some people develop migraine as a result of certain triggers like foods, fragrances, alcohol, caffeine, sleep deprivation, atmospheric changes, hormonal changes, or overexertion. In some cases an individual may get a migraine attack when exposed bright lights or loud noise like in a concert.^[3]

The presenting features of each of the four phases of a migraine attack are different. Silent Migraines does not cause a headache but the other symptoms are similar to those experienced in a regular migraine attack. The severity of the symptoms differs depending on the phase of the attack.^[3]

The presenting features of Silent Migraines according to the phase include:

The prodrome phase of a migraine usually occurs a few hours or a couple of days before the actual attack. The affected individual will appear depressed with no interest in doing any task. He or she will have a tough time focusing on tasks given. They may also find it difficult to speak. There will be frequent periods of excessive fatigue.^[3]

There will be mood swings and the individual will be extremely irritable. The muscles will become stiff with the individual have extreme sensitivity to light and sound. Most of the people experience the prodrome phase before a migraine attack but there have been some cases where this phase has not been experienced.^[3]

This phase of migraine does not always occur. In fact studies suggest that only 25% of people with migraines experience this phase. In cases of a Silent Migraines, the patient will experience the symptoms of aura but without headache. The presenting features of the aura phase include numbness and tingling in the upper and lower extremities.^[3]

In some cases, people have complained of temporary visual impairment or seeing halos around the eyes. These features come on gradually and peak about a couple of hours before the actual onset of migraines.^[3]

This is phase where the patient will suffer a severe headache which will last anywhere from a few hours to a couple of days. Obviously, this is not the case in Silent Migraines. Instead, during phase the patient will experience severe anxiety with dizziness. Inability to sleep even of the patient trues hard. There will be neck stiffness along with nausea with or without vomiting. The nose will be congested. Photophobia and phonophobia may be also present along with other symptoms.^[3]

This phase begins after the migraine attack ends. This is experienced by around 80% of migraine sufferers. This phase lasts for a period of a couple of days. The presenting features of this phase include intense body pains with dizziness. The patient will have difficulty focusing and concentrating. The mood of the patient will be sad and depressed and the patient will feel fatigued.^[3]

In conclusion, Silent Migraines is a subtype of migraines in which the affected individual will have all the phases of a migraine but will not have the typical headache that comes with it. The symptoms of Silent Migraines are quite severe and impact the quality of life of the individual. This is especially if the frequency of these attacks is quite high. On the treatment front, there are a variety of medications which are available over the counter or through prescriptions which can not only prevent an attack but also abort attacks of migraines.^[3]

Migraines tend to be quite severe in people in the teens and may continue till the time they are at their third or fourth decade of life. However, the frequency and intensity of the episodes tend to gradually come down as an individual ages. It is always better for people with migraines to consult with a neurologist even in cases of Silent Migraines to go for a definitive treatment to manage the other symptoms of Silent Migraines and improve the quality of life.^[3]

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