Silent migraines—also called acephalgic migraines—are one of the most misunderstood types of neurological episodes. Unlike typical migraines, they don’t involve head pain. Instead, you experience symptoms like visual disturbances, sensory changes, or language disruptions, without the hallmark throbbing headache².

Because there’s no pain, people often dismiss or misinterpret what’s happening. But silent migraines can be just as disruptive—sometimes even more so—affecting your ability to see, speak, or stay balanced.

What Happens in the Brain During a Silent Migraine?

Even though you don’t feel pain, there’s a lot happening under the surface. Silent migraines involve a neurological process called cortical spreading depression (CSD)¹. Imagine tossing a stone into still water and watching the ripples move outward—that’s CSD in your brain: a slow-moving wave of electrical activity across the outer layer of the brain, the cortex.

Here’s what happens:

• Neurons in your brain fire excessively, releasing chemicals like glutamate and potassium.
• This overactivity is followed by a “crash” phase, where neurons go temporarily quiet.
• Blood flow changes, with initial constriction followed by dilation of blood vessels.

These changes can trigger visual auras, tingling, or speech difficulties; classic migraine symptoms, minus the pain.

Why Doesn’t It Hurt?

In a classic migraine, those neurological and blood flow changes irritate pain-sensitive areas of the brain. In a silent migraine, that pain trigger doesn’t seem to activate, though scientists still don’t fully understand why. Still, the brain’s wiring gets scrambled, and that can feel just as intense, even without pain.

Is It Painful in Other Ways?

Yes—just not in the way you might expect. Silent migraines can cause:

• Dizziness and vertigo
• Nausea
• Extreme fatigue
• Sensitivity to light and sound
• Visual distortions and aura
• Tingling or numbness in the face or limbs
• Language or speech difficulties

These symptoms can be deeply unsettling, especially if you don’t know what’s happening. Even without pain, silent migraines can interfere with your daily life in major ways.

How Long Do Silent Migraines Last?

Aura symptoms typically last 20 to 60 minutes, but lingering effects like fatigue or brain fog may continue for hours or even a day. The episode might seem milder without the headache, but it’s still a full-body neurological event.

Silent Migraine Symptoms to Watch For

Even without head pain, silent migraines can present with several key signs:

• Flashing lights, zigzags, or blind spots (visual aura)
• Tingling or numbness in the limbs or face
• Trouble speaking or finding the right words (aphasia)
• Dizziness or lightheadedness
• Sensitivity to light or sound
• Mild nausea

These symptoms often develop gradually and can occur without a clear trigger. It’s important to note that even pain-free, they reflect significant brain changes and should be taken seriously.

When Should You See a Doctor?

Seek medical attention immediately if:

• Symptoms last longer than one hour or don’t resolve.
• You experience confusion, weakness, or loss of consciousness.
• Your symptoms resemble a stroke (one-sided weakness, facial drooping, slurred speech).
• You’ve never had migraines before, or your symptoms are changing.

Always better to be safe—these symptoms can overlap with serious neurological conditions like stroke or transient ischemic attacks (TIAs).

How Are Silent Migraines Treated?

Even without pain, silent migraines require thoughtful, individualized treatment. From a conventional standpoint, neurologists may recommend:

• Preventive medications, such as beta blockers, anticonvulsants, or CGRP inhibitors³.
• Symptom management with low-dose aspirin or, in some cases, triptans (with caution).

An Integrative Approach

In my practice, I use an integrative approach to treat silent migraines. This may include:

• Acupuncture regulates the nervous system, modulates blood flow, and calms overactivity in the brain⁴.
• Lifestyle and dietary assessments are used to identify triggers like poor sleep, hormone shifts, stress, or specific foods.
• Nutritional support, tailored to neurological and hormonal balance.
• Collaboration with neurologists or primary care providers, when needed.

The goal isn’t just symptom control—it’s to restore balance and build resilience in your nervous system. That’s where integrative care excels: personalized treatment, grounded in both science and holistic insight.

Think You’re Experiencing Silent Migraines?

If you’re dealing with unexplained visual changes, speech issues, or neurological symptoms—even without pain—you don’t have to go through it alone.

Book an appointment today to explore personalized, integrative treatment for silent migraines and get to the root of what’s happening in your body.

References:

1. Ayata C. Cortical spreading depression triggers migraine attack: pro. Headache. 2010;50(4):725-730. doi:10.1111/j.1526-4610.2010.01652.x
2. Viana M, Sances G, Linde M, et al. Migraine aura without headache: a review. Cephalalgia. 2016;36(10):980-986. doi:10.1177/0333102415613614​
3. Edvinsson L. The trigeminovascular pathway: role of CGRP and CGRP receptors in migraine. Headache. 2017;57 Suppl 2:47-55. doi:10.1111/head.1303
4. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-474. doi:10.1016/j.jpain.2017.11.005​