Discussing Migraine can be tricky for many reasons. One difficulty frequently encountered when discussing Migraines occurs when a patient with Migraine is given a diagnosis that isn’t actually accurate in diagnostic terms, but is really a descriptive term.
The terms “acephalgic migraine” and “silent migraine” are a good example of this issue. In this case, the two terms are generally accepted to mean a Migraine attack without the Headache phase. Any type of migraine can be acephalgic.
There are four potential phases of a Migraine attack:
Not everyone with Migraine experiences all four phases, and one Migraine attack can be different from the next. Simply put, an acephalgic Migraine skips the Headache phase.
A patient who is diagnosed with Migraine should be fully diagnosed as to what type of Migraine they have, whether they’re acephalgic or include the Headache phase. There is no diagnostic test to confirm Migraine disease. The diagnosis of Migraine is a diagnosis of exclusion, achieved by reviewing both family and patient medical history, evaluating the symptoms, and performing an examination to rule out other causes of the symptoms. If there is any alteration in consciousness, seizure disorders should also be ruled out.
For infrequent Migraine attacks, even without the Headache phase, medications used for other forms of Migraine are often employed to relieve the other symptoms. These medications can include NSAIDs, anti-nausea medications, ergotamines, or triptans. The choice of medications is somewhat affected by the age of the patient. When Migraines are frequent, the same preventive therapies used for other Migraines can be explored.