Many people are surprised to find out that not all migraines include headaches. While most do produce head pain, they may also include other symptoms of varying intensity which appear in different combinations. Migraines are usually classified into two types: Classic and Common. Classic have visual disturbances, known as auras, and common do not. This article discusses episodes that don't involve any headaches at all.
Facts
Migraines are usually associated with severe headaches, but, as sufferers know, they don't always involve head pain. Some begin with visual symptoms, known as auras, but never lead to a headache. Diagnosing migraines that are not accompanied by pain can be tricky. Approximately one-fifth of sufferers experience aura or visual disturbances such as flashing lights, wavy lines and blind spots that begin from twenty minutes to an hour before the actual full-blown episode. More than 30 million Americans suffer from migraines. A majority of them have family members who share this condition, so there is thought to be a genetic component. Women are affected three times as often as men. Some children have headache-free symptoms, including nausea, vomiting and hypersensitivity to noise and light. Children's migraines, sometimes known as "abdominal migraines," can be difficult to identify, because nausea and vomiting are present in many common childhood illnesses.
Types
Migraines without headaches are known by different names: migraine equivalents, ophthalmic or ocular, all of which fall under the official diagnosis of "Migraine with Aura." Visual symptoms, with or without headaches, interfere with day to day activities and work productivity, such as reading, using a computer and driving. Someone may experience a series of ocular events in a short period of time, and then not have another episode for months or years. Another type is the ophthalmoplegic migraine which involves temporary eye involvement, such as drooped eyelids or changes in pupil size and which may last from several days to several weeks. Because vision is affected, people are advised to consult first with an eye doctor, to rule out other conditions, but usually an eye exam won't provide the answers.
Warning
Vision and visual perception may be impaired significantly during an ocular episode, with or without a headache. These disturbances compromise the safety of the sufferer and the well-being of others, so if you notice any visual symptoms, you should stop what you are doing right away. This is especially important if you are driving or planning to drive. It is not safe to drive or continue driving until the your vision is back to normal. Ideally, if it is possible, you should just stay still or rest in a quiet, darkened room, drink fluids, and place a cool cloth on your forehead until all symptoms stop. Even after the migraine is gone, be cautious. Some symptoms linger, such as disorientation, unclear thinking, neck pain, body aches and an overwhelming desire to sleep.
Causes
No one knows exactly what causes ophthalmic migraines. In some people, it may be related to consuming certain foods such as chocolate, nuts, red wine, shellfish, MSG, sugar substitutes, caffeine or alcohol. Some people believe that tension and fatigue are triggers, but researchers have not found a definite link. Auras were once thought to be caused by constriction of small arteries leading to the brain, but now it is believed that they are the result of intermittent changes in the activity of certain nerve cells. Vision symptoms accompanying headache-free migraines tend not to be related to the eyes. These visual distortions probably occur as a result of brain activity in the visual cortex, which is located in the back of the skull.
Symptoms
Migraines vary in intensity and occur in many combinations. The headache-free variety occur with diverse visual symptoms. Some people see a small blind spot called a "scotoma," which expands and spreads through their field of vision. Often this blind spot is accompanied or followed by flickering lights called "scintillations and/or metamorphosia" in which straight lines appear wavy. Sometimes shimmering, zigzagging lines or spinning stars appear inside the blind spot. Some visual symptoms last only a few minutes, but more often they continue for up to an hour. These painless, "silent" migraines often appear suddenly, and they have been described as creating "the sensation of looking through a cracked window."
Treatment
Treating, preventing or curing vision distorting migraines is very difficult, because specific triggers are in most cases unknown. If they continue, worsen or lead to headaches, it is important to talk to a knowledgeable doctor who may be able to recommend appropriate treatment for your condition. Normally, you will not need to take prescription drugs for ophthalmic migraines, but if your symptoms increase, you may need to try medication to reduce their intensity and frequency.
Keeping a headache diary (see link below) is a productive way to learn more about your condition and to identify triggers. Having this kind of personal record may help you describe, predict, reduce and possibly prevent your migraines.
