Silent Migraine

hello everyone and welcome to headwise the video cast and podcast of the national headache Foundation I'm Dr Lindsay whitel I the founder of migraine nation and I have a history of chronic and daily migraine that began at the age of four I'm super excited to tell you that I am here today with Dr hope O'Brien hi Dr O'Brien how are you today hi Dr whitel it's so good to be here with you well we are happy you're here she is the CEO and medical director of the headache Center of Hope in Cincinnati Dr O'Brien is a board certified neurologist and headache specialist she is also a board member of the national headache foundation and I am super excited to hear what she has to say about our topic today we see a lot and hear about silent migraine it's also known as aalc migraine or migraine that presents without headache meaning it only really comes with an aura the icd3 refers to this as typical Aura without headache this may be one of those podcast episodes where some of the audience members might listen and suddenly realize they might experienced this on occasion and never really realized it so let's go on with this interesting topic Dr Brian can you first give us some background by just letting everyone know how head pain and Aura usually present during a typical migraine attack sure well headache is a symptom it doesn't really tell us the underlying cause so a headache is a symptom just like belly pain or back pain we don't know what the underlying cause is now migraine is a diagnosis that includes moderate to severe head pain and typically the pain is one-sided but it can involve both sides of the head the headaches tend to be throbbing or pulsating in nature and the pain tends to last about four hours in adults a little bit shorter in children children the headache is not just the only symptom in migraine but patients will often complain of light sensitivity or Sound Sensitivity nausea and or vomiting and all you need for the diagnosis is five attacks in a lifetime now a third of patients will actually get Aura which is typically a warning sign that the migraine is about to start how is this different in migraine Ora without headache what what how does this present differently sure well about a third of patients will actually get Aura with their migraine as I mentioned before like a warning sign but what Aura without a headache is is patients will get that typical aura or warning sign without the headache so the most common warning sign that patients will complain about is visual changes so they'll say they see squiggly lines or flashing lights or they may get a halo around certain objects they may also get sort of a loss of peripheral vision so those are some of the warning signs and that's an indicator for patients that I better get ready a migraine is about to start well the aura without the headache they'll have those same features but the headache never starts okay so when someone experiences a silent migraine what types of Aura might they experience is it always a visual Aura great question no not necessarily so there are different types of Aura visual tends to be the most common other types of Aura include numbness or tingling or more of a tactile Aura um some patients May um experience difficulty in their speech or language so those are you know the most common types and in a very rare type of Aura patients will experience weakness or an inability to use an arm and a leg so that TS occur with the family history but again the most common is the visual and these Aura tend to last anywhere between five minutes to 60 Minutes anything outside of that is what we would call prolonged or atypical Aura okay can these auras uh and these I should say can silent migraine in and of itself be debilitating even though it is not painful yes absolutely imagine you're driving a car and you lose vision or you're typing on something and all of a sudden you have a visual change occur so they can absolutely be disabling and so it's something that we need to address and manage for the safety of not only you but other people so just out of curiosity is silent migraine managed in the same way as more typical migraine attacks it is now there's not a lot of research done on silent migraine however what we know is that by treating migraine in general it tends to improve all of the symptoms including Aura so in patients who can basic basically tell when a migraine is going to begin either with an ore or maybe a prodrome they might want to do some things to prepare themselves prior to that headache starting there's also preventive treatment that can be started that can help minimize the the likelihood of an aura coming or those migraine symptoms okay so just another curious question does this type of migraine this silent migraine occur in people who also experience regular Migraine with pain yes absolutely and in fact that is the definition you have to have a diagnosis of migraine first before you make the diagnosis of Aura without migraine and the reason why is there are certain mimics of Aura so a mimic are seizures so a seizure can present as an aura and then stroke is the other condition that can present as an aura so we need to really make sure that first of all the pattern and the characteristic of the aura are pretty much the same every time and in patients who have a history of migraine I tend to worry if somebody is older than the age of 50 and all of a have these warning signs or they have these warning signs with other type of symptoms such as confusion or maybe visual change with numbness and tingling because I worry about either a stroke or a seizure so yes okay typically patients have a diagnosis migraine okay so that was going to be one of my next questions so I'm glad you said that there's things that need to be ruled out if someone thinks that they're experiencing this and then so another follow-up question would be is someone already experiences typical migraine and then they feel like they're experiencing silent migraine too how do they know when to either seek out the advice of their physician related to this silent migraine or treat it should they be randomly trying to let's say use their triptans also for this situation that feels like silent migraine or should they be going to a physician what's the next step if they feel like they might have this great question so what I would say to somebody who has migraine and have migraine with aura in other words have a warning sign be before they get the migraine if it's a aura that's typical of of their migraine and there's no other symptom then I would say you know what I would be less cautious however if a patient develops an aura without the migraine and it's their first time developing an aura then I would say absolutely it needs to be checked out especially if it's associated with confusion or num or tingling or weakness again we want to make sure that we're ruling out any secondary causes any older patients for the first time developing an aura without any headache again as you age your risk for stroke increases so we want to make sure that we address that as soon as possible okay great this has been a great discussion and this is a topic we don't we hear the words but we don't hear a lot of information about it so I'm so glad that we covered this is there anything else you'd like to add to this discussion no except for thank you for having this discussion and you're right it's rare that we see it but I think it's important for your listeners to know and viewers to know kind of what to look for in case there is something unusual that occurs all right well thank you so much for being here and thank you everyone for listening in to this episode of headwise you all have a great and wonderful pain-free day

Channel: National Headache Foundation

Views: 1,550

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Id: 5_XELZanR6o

Length: 8min 34sec (514 seconds)

Published: Fri Feb 09 2024