The National Migraine Association outlines four phases of a migraine that include a predrome, aura, attack and postdrome. Doctors diagnose migraines after determining that at least three of the four phases are occurring. Acephalic migraine sufferers do not experience the attack or headache phase, which can make an acephalic migraine difficult to diagnose. All migraine subtypes except for migraines without auras can be acephalic or silent.
Significance
The "American Journal of Managed Care" indicates that over $15 billion is spent annually to diagnose and treat migraines. Moreover, the journal estimates that migraines result in several more billion lost to decreased work productivity each year. Silent migraines account for a large percentage of diagnostic costs since an intense, often debilitating headache is the primary indicator used by many physicians of a migraine. Distortions that include blurred vision, blindness or colored blotches are common in acephalic migraines, which requires detailed neurological tests to rule out a detached retina or aneurysm. Any disruption to your vision should be immediately examined by a doctor to ensure that one of these more serious conditions is not present.
Identification
There are several dozen migraine subtypes listed by the National Headache Foundation that usually describe the principal symptoms or cause of the migraine. The predrome describes the first predictors of an oncoming migraine. Typically, strong sounds, smells or lights will trigger a migraine. If you are able to take preemptive action at the first indication of a migraine attack, you may be able to prevent the migraine from occurring. Auras are the second phase of a migraine and can involve blurred vision, color distortions, or blindness. Acephalic migraines do not have the "attack" phase specifically; however, a dull throb or overall body ache may be a part of the predrome or postdrome migraine phases. Additionally, the postdrome may include an overwhelming sense of fatigue and nausea. The combination of triggers and symptoms are unique to each migraine sufferer.
Causes
Visual symptoms associated with acephalic migraines are typically due to small blood vessel contractions in the brain's visual cortex or surrounding the eye. Dilation of blood vessels in other parts of the brain can instigate all of the predrome and postdrome symptoms experienced. Dr. Ofner, a renowned ophthalmologist, describes this process as localized vasospasms. In order for this vasospasm to not induce an intense headache in acephalic migraines, the constrictions must be too small to trigger pain receptor response or other neurological functions are drastically impaired before the headache occurs
Prevention
Prevention requires identification of your migraine triggers. Keeping a detailed journal will help eliminate possible triggers, which are commonly food or environmental allergies, intense odors or lights or repetitive flashing or beeping.
Treatment
The National Headache Foundation lists three primary types of medication to treat acephalgic migraines: beta blockers, anti-depression and anti-seizure. Non-prescription migraine medication may treat any pain associated with predrome or postdrome symptoms; however, none of the currently available migraine preventative medications are available without a prescription. Beta blockers are effective at improving circulation by lower blood pressure and reducing the hearts need for blood and oxygen. Anyone who has any form of heart or circulatory problems will not be able to take this medication, and any cut or injury must be examined by a physician while on this preventative due to the risk of excessive bleeding. Anti-depression and anti-seizure medication modulates neuronal responses to all stimuli and subsequently raises the body's threshold for pain according to the Mayo Clinic.
References
- MAGNUM: The Four Phases of Migraine
- "The Cost of Migraine and Its Treatment." Dr. Lawrence D. Goldberg. The American Journal of Managed Care. 2005.
- National Headache Foundation: The Complete Guide to Headaches
- Eugene Eye Care: Dr. Ofner, Ophthalmologist
- The National Migraine Association: Beta-adrenergic Blocking Agents
