Learn more about migraine aura without headache, why you should visit a doctor, and available treatment options
A small percentage of people with migraine experience an aura that is not followed by head pain. Migraine aura without headache is fairly uncommon and can be hard to distinguish from other visual disturbances, so we reached out to Dr. Kathleen Digre to learn more.
Dr. Digre is a distinguished professor of neurology and ophthalmology and director of the Headache Clinic at the University of Utah. She is also the immediate past president of the American Headache Society and a former president of the North American Neuro-Ophthalmology Society.
What Is Aura?
Aura is a series of sensory disturbances, often serving as a “warning sign” of a migraine attack in about a quarter of people with migraine. It is usually visual in nature, such as seeing spots, zig zags, flashes or even losing sight for a short time. “Most of the time [the aura] starts in the center of vision and goes out. And it often goes out to one side or the other side,” says Dr. Digre. “It makes the person who has it think that it’s in one eye… but it’s actually coming from the brain, from the occipital lobe.”
Aura can also cause sensory changes, like numbness or tingling in the face, body or hands, or speech and language problems.
What Is Migraine Aura without Headache?
For most people, a headache follows the aura. “But some people don’t get the headache; they just get the aura,” says Dr. Digre. That is what is known as migraine aura without headache.
Migraine aura without headache is not very common. Only about 4% of people with migraine have aura without headache. It commonly occurs in two age groups: young adults in their 20s and 30s, and older adults between 40 and 60 years old.
“People who have migraine with aura with headache, sometimes will lose their headache as they get older. So the headache part goes away, and the aura continues,” says Dr. Digre. Almost 40% of people who’ve had migraine with aura in later life will get aura without headache.
Migraine aura without headache is sometimes referred to as “ocular migraine,” a common misnomer. “Ocular migraine is not even in the International Classification Of Headache Disorders,” explains Dr. Digre, “It doesn’t exist.”
The Importance of Consulting a Doctor
It’s important to visit a doctor if you experience migraine aura without headache frequently. This can help rule out other conditions that cause aura or visual disturbances and get an accurate diagnosis.
“Episodic aura without headache is usually not a problem. It’s a nuisance. It happens maybe one or two times a year,” says Dr. Digre. “It’s the people who get the frequent aura without headache that I want to see, evaluate and make sure that nothing else is going on.”
Your doctor can conduct an examination to make sure there’s no sign of a visual field defect or permanent impairment, and may also order an MRI scan or bloodwork. Blood tests can help distinguish migraine aura without headache from other conditions such as autoimmune conditions. Persistent aura can be seen with a stroke, so getting the correct diagnosis is really important.
How to Tell if it’s Aura or Something Else
Two distinguishing factors of migraine aura without headache is that it affects both eyes—not just one eye—and there is a build-up of the aura. The aura will often change during the first five minutes or so, and it can last up to an hour.
When a person experiences aura, it can be difficult to determine whether the visual disturbance is in one or both eyes. Dr. Digre has a simple exercise to help patients pinpoint what’s going on: Open a book or something you can look at and read. Cover one eye and look at your book. If you can see the aura covering up the words on the page, you know it’s in that eye. Then cover the other eye, and if you still see the aura, you know it’s in that eye as well. “I would encourage every person who has an aura to confirm that it’s in both eyes because that puts it in the occipital lobe and in the brain [rather than in one of the eyes],” she says.
Because many people with migraine experience visual symptoms or light sensitivity, it can be confusing to distinguish or describe exactly what’s going on. Contact your doctor to discuss your symptoms and how to best evaluate and diagnose what you’re experiencing.
Treating Migraine Aura without Headache
When migraine aura without headache is frequent or severe, your doctor can recommend treatment options, such as low dose aspirin, calcium channel blockers or other medications.
“My favorite treatment has been baby aspirin, if they don’t have any contraindication for baby aspirin,” says Dr. Digre. “Calcium channel blockers often will treat aura without headache if it’s frequent.”
For people who experience onset of migraine aura later in life, the symptoms can be very severe and last for several days. In that case, Dr. Digre usually prescribes a calcium channel blocker, but other medications can be used.
There aren’t any specific lifestyle adjustments to treat migraine aura without headache. However, taking steps like getting adequate sleep, decreasing stress and avoiding known migraine triggers may help prevent aura without headache.
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Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.