Migraines are diagnosed by whether a sufferer experiences three of the four phases: predrome, aura, headache and prodrome. Acephalgic migraines lack the headache phase and are often referred to as silent migraines. Migraines with a headache and without an aura are the most prevalent type; however, any of the migraine subtypes that have an aura may also be acephalgic.
Significance
The World Health Organization lists migraines as the 19th ranked disability-inducing disease, and the National Headache Foundation indicates that over 30 million people suffer from migraines in the United States alone. Given that migraine prevalence has increased by 60 percent according to the National Migraine association, the likelihood of a migraine affecting your daily life is higher. Dr. Lawrence Goldberg estimates that approximately 15 billion is spent annually in the United States on emergency room visits, diagnostic lab tests, medications and lost work productivity. Acephalgic migraines contribute a large amount to diagnostic testing since they are more difficult to diagnose since most people assume that a headache must accompany a migraine.
Identification
The National Headache Foundation characterizes several potential triggers for acephalgic migraines. Extreme sensitivity to strong smells or light are common instigators of the predrome. Auras vary widely from person to person. Typically, auras are described as blurred vision or blindness and color distortions in both eyes. There is no headache phase. The recovery period also known as prodrome often consists of nausea, fatigue or vomiting. Acephalgic migraines are often diagnosed by the visual distortions perceived during the aura phase. All migraines that effect vision should be looked at by a medical professional to ensure that no other serious medical condition exists. This especially applies if visual distortions are limited to one eye.
Causes
Acephalgic migraines have two main causes. First, vasospasm occurring near thevisual cortex or eye may produce the visual distortions according to Dr. Ofner, an ophthalmolgist. Secondly, small dilations of blood vessels may occur anywhere in the brain to produce all the migraine systems. In acephalgic migraines, these dilations are too small to be perceived by the pain center of the brain and don't produce a headache but may still cause nausea, fatigue or vomiting.
Prevention
Preventing acephalgic migraines will require the sufferer to keep a detailed diary. Migraine triggers may be food allergens, strong odors, bright lights or cleaning products. Since triggers are unique to each person, keeping a detailed diary will allow the sufferer to determine the common factors that occur before migraine onset. These common factors are the most likely triggers and should be avoided.
Treatment
Since the primary symptoms of acephalgic migraines are visual, over-the-counter pain medication will not help. The National Headache Foundation suggests several types of preventative medications including epilepsy, beta-blockers and depression medication. In order to be preventative, these medications most be taken daily and have numerous potential side effects. Epilepsy and depression medications work by modulating neuronal responses in the brain so that each action requires a larger stimulus. Beta-blockers, however, lower the likelihood of blood vessel constriction by improving overall blood circulation and reducing the hearts need for oxygen and blood. Consultation with your physician will help determine the appropriate medication to prevent your symptoms.
