Aura without headache

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Aura without headache, previously known as acephalgic migraine, is the occurrence of aura without the headache.[1]

Symptoms and misdiagnosis

It is a relatively uncommon variant of migraine in which the patient may experience some migraine symptoms such as aura, nausea, photophobia, and hemiparesis, but does not experience headache.[2] It is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache.[3][4] It is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.[5]

Acephalgic migraines can occur in individuals of any age.[6] Some individuals, more commonly male, only experience acephalgic migraine, but frequently patients also experience migraine with headache.[7] Generally, the condition is more than twice as likely to occur in females than males.[8] Pediatric acephalgic migraines are listed along with other childhood periodic syndromes by W.A. Al-Twaijri and M.I. Shevell as "migraine equivalents" (although not listed as such in the International Classification of Headache Disorders), which can be good predictors of the future development of typical migraines.[9][10] Individuals who experience acephalgic migraines in childhood are highly likely to develop typical migraines as they grow older.[11] Among women, incidents of acephalgic migraine increase during perimenopause.[8]

Scintillating scotoma is the most common symptom[12] which usually happens concurrently with Expanding Fortification Spectra.[13] Also frequently reported is monocular blindness.[14] Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds.[15] On rare occasions, they may continue for up to two days.[2]

Acephalgic migraines may resemble transient ischemic attacks or, when longer in duration, stroke.[2][16] The concurrence of other symptoms such as photophobia and nausea can help in determining the proper diagnosis.[16] Occasionally, patients with acephalgic migraine are misdiagnosed as having epilepsy with visual seizures, but the reverse misdiagnosis is more common.[17]


The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine, but the symptoms are usually less severe than those of classic migraine, so treatment is less likely to be required.

See also


  1. Garza, Ivan; Robertson, Carrie E.; Smith, Jonathan H.; Whealy, Mark E. (2022). "102. Headache and other craniofacial pain". In Jankovic, Joseph; Mazziotta, John C.; Pomeroy, Scott L. (eds.). Bradley and Daroff's Neurology in Clinical Practice. Vol. II. Neurological disorders and their management (8th ed.). Edinburgh: Elsevier. p. 1757. ISBN 978-0-323-64261-3. Archived from the original on 2023-06-30. Retrieved 2023-06-12.
  2. 2.0 2.1 2.2 Goroll, Allan H.; Albert G. Mulley (2009). Primary Care Medicine: Office Evaluation and Management of the Adult Patient (6th ed.). Lippincott Williams & Wilkins. p. 1152. ISBN 978-0-7817-7513-7.
  3. Pryse-Phillips, William (2003). Companion to clinical neurology (2nd ed.). Oxford University Press US. p. 587. ISBN 0-19-515938-1.
  4. Bradley, Walter George (2004). Neurology in clinical practice. Vol. 2 (4th ed.). Taylor & Francis. p. 2074. ISBN 0-7506-7469-5.
  5. Bernstein, Carolyn; Elaine McArdle (2009). The Migraine Brain: Your Breakthrough Guide to Fewer Headaches, Better Health. Simon and Schuster. p. 36. ISBN 978-1-4165-4769-3.
  6. Engel, Jerome; Timothy A. Pedley; Jean Aicardi; Marc A Dichter (2008). Epilepsy: a comprehensive textbook. Vol. 1 (2nd ed.). Lippincott Williams & Wilkins. p. 2695. ISBN 978-0-7817-5777-5.
  7. Miller, Neil R.; Frank Burton Walsh; Valérie Biousse; William Fletcher Hoyt (2005). Walsh and Hoyt's clinical neuro-ophthalmology. Vol. 1 (6th ed.). Lippincott Williams & Wilkins. p. 1289. ISBN 0-7817-4811-9.
  8. 8.0 8.1 Loder, Elizabeth; Dawn A. Marcus (2004). Migraine in women. PMPH-USA. p. 21. ISBN 1-55009-180-8.
  9. Al-Twaijri, WA; Shevell, MI (May 2002). "Pediatric migraine equivalents: occurrence and clinical features in practice". Pediatric Neurology. 26 (5): 365–8. doi:10.1016/S0887-8994(01)00416-7. PMID 12057796.
  10. Lipton, Richard B.; Marcelo Eduardo Bigal (2006). Migraine and other headache disorders. Neurological disease and therapy. Vol. 85. Informa Health Care. p. 204. ISBN 0-8493-3695-3.
  11. Greenberg, Mark S. (2006). Handbook of neurosurgery (6th ed.). Thieme. p. 45. ISBN 3-13-110886-X.
  12. Gilroy, John (2000). Basic neurology (3rd ed.). McGraw-Hill Professional. p. 127. ISBN 0-07-105467-7.
  13. G. D. Schott (2007). "Exploring the visual hallucinations of migraine aura: the tacit contribution of illustration". Brain. 130 (6): 1690–1703. doi:10.1093/brain/awl348. PMID 17264093.
  14. Irwin, Richard S.; Frederick J. Curley; Ronald F. Grossman (1997). Diagnosis and treatment of symptoms of the respiratory tract (2nd ed.). Wiley-Blackwell. p. 607. ISBN 0-87993-657-6.
  15. Amos, John F. (1987). Diagnosis and management in vision care. Butterworths. p. 16. ISBN 0-409-95082-3.
  16. 16.0 16.1 Lee, David A.; Eve J. Higginbotham (1999). Clinical guide to comprehensive ophthalmology. Thieme. p. 532. ISBN 0-86577-766-7.
  17. Panayiotopoulos, Chrysostomos P. (2007). A Clinical Guide to Epileptic Syndromes and Their Treatment (2nd ed.). Springer. pp. 107–108. ISBN 978-1-84628-643-8.