Migraine without aura
Migraine without aura is the most common form of migraine, affecting roughly three out of every four people who experience this neurological condition. Unlike migraine with aura, attacks occur without warning signs like flashing lights or vision problems, but the pain and other symptoms can be just as disabling.
Table of contents
- What is migraine without aura?
- Symptoms
- How long attacks last and how often they occur
- What causes migraine without aura?
- Treatment options
- Lifestyle changes that can help
What is migraine without aura?
Migraine without aura is a type of neurological disorder (a condition related to the nervous system) that causes recurring attacks of moderate to severe headache along with other symptoms[1]. It is the most common type of migraine, accounting for approximately 75% of all migraine cases[3].
The key difference between migraine without aura and migraine with aura is that people with migraine without aura do not experience aura, which is a set of neurological symptoms that some people get before or during a migraine attack. Aura symptoms include things like problems with sight (such as flashing lights or blind spots), speech difficulties, and sensory disturbances like tingling or numbness[1].
Some people experience both types of migraine attacks at different times. You may have some attacks with aura and others without aura[1].
Migraine is much more than just a bad headache. It is a complex neurological event that can significantly impact daily activities and quality of life[2]. The condition affects approximately 44.5 million adults in the United States, with women being affected roughly three times more often than men[2][8].
Symptoms
During a migraine attack without aura, you may experience several symptoms that together make it difficult or impossible to carry out your normal daily activities[1].
The headache itself typically has specific characteristics. The pain is often felt on one side of your head, although it can affect both sides. The pain is usually throbbing or pulsating in nature. Movement makes the pain worse, so activities like walking or climbing stairs can intensify the discomfort. The headache is moderate to severe in intensity, meaning it is severe enough that you cannot do your normal daily activities[1][3].
Along with the headache, you will typically experience at least one of the following additional symptoms. You may feel sick to your stomach (nausea) or actually be sick (vomiting). Many people become very sensitive to light (called photophobia), sound (called phonophobia), and sometimes smells during an attack[1][3].
Some people also experience warning signs before the headache begins, in what is called the prodrome phase. These early symptoms can start up to 24 hours before the headache and may include mood changes, difficulty concentrating, trouble sleeping, fatigue, increased hunger and thirst, or frequent urination[2].
After the headache ends, you may enter a postdrome phase, sometimes called a migraine hangover. During this time, which can last from a few hours up to 48 hours, you may feel fatigued, have a stiff neck, remain sensitive to light and sound, have difficulty concentrating, feel nauseated, or experience dizziness[2].
How long attacks last and how often they occur
Migraine attacks without aura usually last between four hours and three days if they are not treated or if the treatment does not work effectively[1][3].
The frequency of attacks varies greatly from person to person. Some people may have migraine attacks only once every few years, while others may experience them several times a week[1]. On average, most people experience migraine attacks two to four times per month, though this can range from as little as one per year to as often as one per week[2].
What causes migraine without aura?
Scientists are not entirely sure what causes migraine, but research suggests it is a complex neurological condition that involves changes in the brain. The condition appears to involve several brain chemicals, including serotonin, calcitonin gene-related peptide, and dopamine[5].
According to current understanding, a wave of nerve cell activity spreads across the brain and affects the trigeminal nerve (a major nerve in the head and face). This triggers the release of chemical messengers that cause changes in blood vessel size and lead to inflammation and pain[5].
Migraine has a strong genetic component and often runs in families. If you have a parent with migraine, there is about a 50 percent chance that you may develop migraine as well[8].
Many different factors can trigger migraine attacks in people who are prone to them. Common triggers include stress, lack of sleep or changes in sleep patterns, certain foods and drinks, not eating enough, dehydration, hormonal changes (especially in women), changes in weather, bright lights, loud sounds, and strong odors[4][6][8]. However, triggers are very personal and what affects one person may not affect another.
Treatment options
Your treatment options depend on how often you have attacks, how severe they are, other health conditions you may have, and other medications you take[1]. Generally, migraine treatment includes two main approaches: acute treatment and preventive treatment.
Acute treatment (also called rescue treatment) aims to help manage the symptoms when an attack comes on. These treatments should be taken as soon as your head pain starts[1]. Options include over-the-counter painkillers like acetaminophen or nonsteroidal anti-inflammatory drugs, migraine-specific treatments called triptans, and anti-sickness medication to help with nausea and vomiting[1][11].
Nonsteroidal anti-inflammatory drugs are recommended as a first-line treatment for mild to moderate migraine, while triptans are first-line treatments for moderate to severe migraine[11]. Several different triptans are available with different ways of taking them, including tablets, nasal sprays, and injections.
You need to be careful not to take certain acute treatments too many days per month, as this can cause medication overuse headache, which is a type of headache caused by taking pain medication too frequently[1].
Preventive treatment aims to reduce how often you have migraine attacks and how severe they are. These treatments are taken regularly, not just when you have an attack, and you build them up to an effective dose over time[1]. Options include beta-blockers, tricyclic antidepressants, anti-epilepsy drugs, and newer treatments such as CGRP inhibitors that are given as monthly or quarterly injections[1][10].
Some people need to try a range of different treatments before finding what works best for them. If treatments are not working effectively, you may be referred to a headache specialist[1].
Lifestyle changes that can help
Alongside medical treatments, many people benefit from making lifestyle changes that can help reduce the frequency and severity of migraine attacks[1][12].
Maintaining a regular routine is particularly important for people with migraine because they have a sensitive nervous system. Sticking to a routine helps keep your lifestyle stable and consistent, which may reduce the likelihood of attacks[1]. This includes waking up at the same time each day, practicing good sleep habits, eating regularly at similar times each day, avoiding getting too hungry, and staying well hydrated[1][12].
Regular gentle exercise, such as walking, and maintaining a healthy lifestyle can also help reduce migraine frequency[1]. Research shows that people with migraine who exercise for at least two and a half hours per week may have fewer migraine attacks each month[23].
If you can identify specific factors that seem to trigger your migraine attacks, such as alcohol or lack of sleep, there might be changes you can make to help reduce how often you have attacks[1]. Keeping a headache diary can help you identify your personal triggers[12].
Managing stress is also important, as stress is a common migraine trigger. Techniques such as relaxation exercises, yoga, biofeedback, and cognitive behavioral therapy may be helpful[12].
Some people find that certain dietary supplements may help prevent migraine attacks. These include magnesium, riboflavin (vitamin B2), and coenzyme Q10, although you should discuss these with your healthcare provider before starting them[12].
