An Aura Without the Headache

Question: Sometimes I see an aura, and expect to get a migraine, but the headache never comes on. What is this?

Dr. Haplea: This type of event has the accurate if uninventive name of migraine aura without headache. Previously called ‘migraine equivalent’ or ‘acephalic headache,’ this type of aura is identical to those occurring with headache in that they begin slowly, typically last about 20 minutes, and usually resolve within 60 minutes. Many migraine patients experience a combination of events, including migraine aura without headache, migraine headache with aura (‘classic migraine’) and migraine headache without aura(‘common migraine’), over the course of their migraine disorder.

The aura is most commonly a visual disturbance such as flickering lights (scintillations), jagged or zigzag lines in an arc (fortification spectra), flashes of light (photopsias), black or gray spots (scotoma), changes in the apparent size of objects (micropsia or macropsia), or changes in the way you see shapes of objects (metamorphosia). Sensory auras can involve tingling or numbness of a small area, or an entire side of the body. Motor auras present as weakness in one part or one side of the body or face. Less common auras include dizziness, clumsiness, double vision, speech disturbance or confusion. Typically, a repetitive or stereotyped pattern is seen with migraine aura without headache. In other words, you’re likely to experience the same thing each time.

A neurologist tries to investigate whether your migraine aura without headache is truly just that, or if a more serious event called a transient ischemia attack (TIA or mini-stroke) is the problem. Symptoms occurring due to a TIA are usually more abrupt in onset and, if recurrent, may not be the same each time. Individuals with vascular disease risk factors (smoking, hypertension, diabetes, heart disease, blood clots, oral contraceptive use, family history of stroke, etc.) should see a neurologist for a full evaluation to rule out TIA. In addition, other neurological conditions can mimic migraine aura without headache, so a visit to the doctor is in order.

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