Acephalgic migraine is a neurological syndrome. It is a relatively uncommon variant of migraine

Migraine

Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...

 in which the patient may experience aura

Aura (symptom)

An aura is a perceptual disturbance experienced by some migraine sufferers before a migraine headache, and the telltale sensation experienced by some people with epilepsy before a seizure. It often manifests as the perception of a strange light, an unpleasant smell or confusing thoughts or...

, nausea

Nausea

Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...

, photophobia

Photophobia

Photophobia is a symptom of abnormal intolerance to visual perception of light. As a medical symptom photophobia is not a morbid fear or phobia, but an experience of discomfort or pain to the eyes due to light exposure or by presence of actual physical photosensitivity of the eyes, though the term...

, hemiparesis

Hemiparesis

Hemiparesis is weakness on one side of the body. It is less severe than hemiplegia - the total paralysis of the arm, leg, and trunk on one side of the body. Thus, the patient can move the impaired side of his body, but with reduced muscular strength....

 and other migraine symptoms but does not experience headache

Headache

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

. While it is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache

Headache

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...

, it is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.

Symptoms and misdiagnosis

Acephalgic migraines can occur in individuals of any age. Though there are some individuals—more commonly male—who only experience acephalgic migraine, frequently patients also experience migraine with headache. Generally, the condition is more than twice as likely to occur in females than males. Although not listed as such in the International Classification of Headache Disorders

International Classification of Headache Disorders

The International Classification of Headache Disorders is a detailed hierarchical classification of all headache-related disorders published by the International Headache Society...

, pediatric acephalgic migraines are listed along with other childhood periodic syndromes by W.A. Al-Twaijri and M.I. Shevell as "migraine equivalents", which can be good predictors of the future development of typical migraines. Individuals who experience acephalgic migraines only in childhood are highly likely to develop typical migraines as they grow older. Among women, incidents of acephalgic migraine increase during perimenopause.

Scintillating scotoma

Scintillating scotoma

Scintillating scotoma is the most common visual aura preceding migraine and was first described by 19th century physician Hubert Airy . It is often confused with ocular migraine which originates in the eyeball or socket.-Presentation:...

 is the most common symptom. Also frequently reported is monocular blindness. Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds. On rare occasions, they may continue for up to two days.

Acephalgic migraines may resemble transient ischemic attack

Transient ischemic attack

A transient ischemic attack is a transient episode of neurologic dysfunction caused by ischemia – either focal brain, spinal cord or retinal – without acute infarction...

s or, when longer in duration, stroke

Stroke

A stroke, previously known medically as a cerebrovascular accident , is the rapidly developing loss of brain function due to disturbance in the blood supply to the brain. This can be due to ischemia caused by blockage , or a hemorrhage...

. The concurrence of other symptoms such as photophobia and nausea can help determining the proper diagnosis. Occasionally, patients with acephalgic migraine are misdiagnosed as suffering epilepsy

Epilepsy

Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

 with visual seizure

Seizure

An epileptic seizure, occasionally referred to as a fit, is defined as a transient symptom of "abnormal excessive or synchronous neuronal activity in the brain". The outward effect can be as dramatic as a wild thrashing movement or as mild as a brief loss of awareness...

s, but the reverse misdiagnosis is more common.

Treatment

The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine but, as the symptoms are usually less severe, treatment is less likely to be required.