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Migraine aura without the headache. Vision disturbance, numbness, difficulty finding words — the warning phase of a migraine that never becomes one. Unsettling in itself, and easily mistaken for something more serious in both directions.
The symptoms of silent migraine can look identical to a stroke or a transient ischaemic attack — sudden visual loss, numbness, weakness, or difficulty speaking.
If this is the first time it has happened, or if it is different from your usual pattern, go to an emergency department now. Do not wait for it to pass and do not wait for a clinic appointment.
Only after those causes have been excluded — usually at a first assessment — can these episodes safely be attributed to migraine. Nothing on this page is a substitute for that.
An aura is the warning phase of a migraine — a reversible disturbance of vision, sensation, movement or speech that usually arrives before the headache. Around a quarter to a third of people with migraine experience aura.
In silent migraine the aura happens and the headache does not. Everything else about the attack can still occur: the warning changes beforehand, the nausea and light sensitivity during, and the exhaustion afterwards.
It is less common than migraine with aura, and people who have it usually have other types of migraine as well — including, in some, vestibular migraine, where the disturbance affects balance rather than vision. It can also begin appearing later in life in people who have had migraine for years — the headaches recede, the auras continue.
Migraine moves through four phases. Silent migraine has three of them.
Visual — wavy or jagged lines, flashing lights, dots or spots, blind spots, tunnel vision.
Sensory — numbness, tingling or a pins-and-needles feeling, often spreading gradually up an arm or across the face.
Speech and other senses — difficulty finding or saying a word, trouble hearing, unusual smells or tastes, weakness.
This is the phase that does not happen. Other features of the attack — nausea, vomiting, hot flushes and chills, a stuffy or runny nose, dizziness, a sore neck or jaw, sensitivity to light, sound, smell, touch or motion, and confusion — can still occur without any head pain.
Feeling drained and washed out, with difficulty concentrating. People often find this the most disruptive part, because without a headache to explain it there is nothing obvious to point to.
This is the central question, and it is a clinical judgement rather than something to work out at home. The features below are what an assessment looks for — set out here so you understand what you will be asked, not so you can rule anything out yourself.
| Migraine aura | Stroke or TIA | |
|---|---|---|
| How it starts | Gradually, building and spreading over several minutes | Suddenly, at full intensity within seconds |
| What you notice | Things added — zigzags, flashes, tingling | Things lost — vision gone, numbness, weakness |
| How it spreads | Migrates, for example from hand to arm to face | Affected area is involved from the outset |
| How long | 20 to 60 minutes, resolving fully | Variable; may not resolve |
| History | Often a long record of similar episodes | Typically new |
None of that is reliable enough to act on alone. Strokes can be gradual and auras can be abrupt. A first episode, or any episode that differs from your established pattern, is assessed as a stroke until proven otherwise. That is the correct order, and it is what we would do.
Diagnosis rests on the history, the pattern of episodes, and a neurological examination — and, importantly, on excluding the alternatives. Investigation is directed at that exclusion rather than at confirming migraine, which no test can do:
Once other causes are excluded and a consistent pattern is established, subsequent episodes can usually be managed without repeating the whole workup — which is itself a reason to get a firm diagnosis rather than living with uncertainty.
Because there is no headache to stop, treatment is weighted towards prevention rather than acute relief.
One thing worth raising at the consultation if it applies to you: migraine with aura is relevant to decisions about combined hormonal contraception and about cardiovascular risk. It is a routine consideration, not a cause for alarm, but it is a reason to have the diagnosis recorded properly rather than left informal.
Episodes are disruptive out of proportion to how they sound. Losing part of your vision for half an hour is not compatible with driving, operating machinery or presenting to a room, and the absence of pain makes it harder to explain to an employer than a migraine would be.
Attacks tend to become milder and less frequent with age. Keeping a record of when they occur, what you had been doing, eating and how you had slept is what makes the triggers findable — and it is the most useful thing to bring to an appointment.
Yes. That is what silent migraine is. The aura and the other features of an attack occur; the headache phase does not.
You should not try to decide that yourself. A first episode is assessed as a possible stroke until proven otherwise. Once a specialist has excluded the alternatives and established your pattern, you will know what your own episodes look like — and what would count as a change worth acting on.
That pattern is recognised. In some people who have had migraine for years the headaches recede with age while the auras continue. It still warrants assessment the first time it happens in this new form.
The episodes are not damaging and they resolve. The risks lie elsewhere: in mistaking a stroke for an aura, and in the practical hazard of losing vision or sensation without warning.
No. You can book directly. Bring any scans and reports, and a record of your episodes if you have kept one.
Migraine · Vestibular migraine · Headaches (all types) · Cluster headache · Tension headache · Cervicogenic headache · Ischemic stroke · Stroke · Dizziness and vertigo
If episodes are recurring and you have never had them properly assessed, that is worth putting right. You will leave knowing what they are and what would count as a change to act on.
