Silent migraine, or medically termed as acephalgic migraine, is a migraine minus the throbbing headache that you experience. Instead of the pain, you experience a series of unsettling sensory and neurological symptoms. These ‘auras’ can last for a few minutes to as long as an hour.

As of 2015, according to the National Library of Medicine, silent migraines are a rare type that affects around 3% of women and roughly 1% of men among migraine patients.

The American Psychological Association defines anxiety as “an emotion characterized by apprehension and somatic symptoms of tension in which an individual anticipates impending danger, catastrophe, or misfortune. The body often mobilizes itself to meet the perceived threat: Muscles become tense, breathing is faster, and the heart beats more rapidly.”

As of 2021, 359 million people are affected by anxiety worldwide, according to the World Health Organisation (WHO), making it the most common mental health condition.

Imagine preparing for a major event, a tennis match. You spend weeks training for it, but on the showdown day, when you step onto the court, a sudden uneasiness takes over you. You see certain soft lights moving or flashes in your vision, you feel dizzy, and you go numb right there. You might wonder at that moment whether it’s performance anxiety or a silent migraine.

The confusion is a valid one because silent migraine and anxiety are deeply interconnected, with one often triggering the other. This overlap is not coincidental, but this bidirectional relationship is actually biological.

What are silent migraines? 

During a silent migraine, also known as migraine without headache, certain sensory issues take place in the body.

When you are experiencing a migraine, a wave of electrical activity passes across the cortex, called the Cortical Spreading Depression (CSD), causing aura, the temporary and reversible neurological disruptions in the senses and speech.

Let us understand this with an example, when you throw a stone, that can be anything that triggers you, in a silent pond, the cortex, you see waves moving slowly across the water body, the electrical waves. What follows is stillness, silence, and that is the aura.

When these waves pass across the occipital lobe, located at the back of the brain and responsible for visual processing, visual disturbances occur. When the waves are passing, some neurons become overactive, which is why you see flashes or sparkles, but once the wave has passed and the neurons are suppressed, you see blind spots.

Similarly, when the waves pass through the somatosensory cortex, the area responsible for senses, you experience symptoms like pins and needles. Dizziness and confusion are also common. You encounter these when the waves pass across the different cortical regions responsible for balance and higher processing.

Certain common symptoms of silent migraines include: 

• Vision problems, including flashes, sparkles, wavy lines, and blind spots
• Numbness

• Speech problems
• Dizziness

• Ringing in the ears

You experience these symptoms without a headache, which is the warning that tells you what you are experiencing is a migraine. It can be an unsettling feeling when you do not know why the visual or sensory disruptions are happening, and naturally, one can feel anxious about it.

The link between silent migraine and anxiety
Silent migraine and anxiety are so closely linked that it is often a challenge to distinguish between the two. Why do the two of them feel so familiar? That is because they share the same biological state.

Our brain cells communicate using certain electrical signals. Mainly, there are two types of signals: excitatory signals and calming signals. As the name suggests, the former is for excitation, to encourage certain actions, whereas the latter is for inhibition, to stop unwanted actions.

When you are in a healthy state of mind, the balance between these two works just fine, but when you are anxious or you experience silent migraine, this balance is influenced and shifts toward excitement, which is called cortical excitability.

In this state, the thalamus, the part of the brain that is responsible for relaying and filtering the sensations, becomes sensitive, and as a result, it cannot filter out the unnecessary sensory data, and you are overwhelmed by light, sound, or racing thoughts in your mind.

Cortical spreading depression causes migraines, but it is actually fueled by high levels of glutamate, the most excitatory neurotransmitter, which increases due to anxiety. Bottom line: anxiety sets the stage for silent migraine to thrive.

Furthermore, the neurotransmitters serotonin and norepinephrine act as gatekeepers, blocking pain signals and unnecessary sensations. Their levels are, however, not in balance during both migraine and anxiety, hence they cannot suppress extra sensations that become ‘noise’, and we feel overwhelmed as a result of that.

In the end, silent migraine and anxiety are not simply two conditions occurring side by side; they are two different results of the same unstable neurological environment. Since both conditions share certain pathways to carry out their effects, they often feel so similar, including their symptoms like dizziness, pins and needles feeling, or trouble with eyesight.

Silent migraine vs anxiety 

Do silent migraine and anxiety trigger each other? 

Silent migraine and anxiety are not only connected, but they also trigger each other. The flashes and the dizziness that you experience during silent migraine can be scary; you might not know what is causing them, and your brain can consider it a threat and activate its stress response.

As a result, stress hormones flood your body, and with more adrenaline and glutamate in the brain, which is already in a state of cortical excitability, your migraine further worsens.

Similarly, as mentioned earlier, anxiety lowers the threshold for migraines by keeping glutamate constantly high and serotonin low, and hence preparing the ground for silent migraine.

Furthermore, since you do not experience any pain in silent migraine, your brain actively scans and searches for the issue, any sign of an aura. This activity in itself causes anxiety because your brain cannot find the source of what’s causing you those symptoms.

This forms a cycle between the two where silent migraine and anxiety ‘feed’ each other. Addressing both neurological excitability and the emotional response becomes important in breaking this cycle.

Why should you not avoid symptoms? 

Even today, many of us don’t pay much attention to what’s not causing us pain. We think we are hurt only when we feel the pain physically, and if we do not feel it, then it’s nothing serious. Is it right, though, to avoid these symptoms that do not hurt? No, they are not, because:

Even if it’s your first time experiencing neurological symptoms like disturbances in eyesight, feeling numb, or difficulty in trying to speak, you should not ignore them. While they are common in silent migraines, they can also be caused by something more serious.

When something unfamiliar happens to you with something as important as your body, you do not assume it to be harmless. You try to understand what is causing it.

If you notice your symptoms becoming more intense or frequent, there is a chance that your symptoms are worsening. You might have been able to manage it earlier, but if you let that continue, it can turn into something big and cause further complications.

Repeated migraines, difficulties in vision, or sensory changes should not be overlooked. They can become unpredictable if left untreated and start interfering with your daily and normal functioning.

When the body tries to say something, you do not ignore it. You might not understand what the issue is, but that’s where a professional steps in. Once you identify any such symptoms, you should seek medical help from a mental health professional, such as an anxiety specialist near me, for clarity, to know the root cause of those symptoms, and receive treatment without any delay.

How to manage silent migraine and anxiety? 

You do not remove migraine or anxiety simply because you cannot. You learn to manage them. What you do is stabilize the electrical excitability of your brain while working on your emotions. You can manage both conditions using certain medications, therapies, and lifestyle changes.

Managing silent migraine

There are certain triggers to silent migraines. Hormonal changes, caffeine, skipping meals, and loud noises are some of those. First, you need to identify what triggers your silent migraine.

To do so, you can keep a record of every time you have a migraine without headache, what you did, what you ate, and anything that stands out to you. This way, you can identify your trigger and avoid it in the future.

Medications are another option to manage your migraine symptoms. If you are someone who experiences frequent sensory issues or your migraines are way too intense, your doctor might prescribe you medications that prevent their occurrence.

Managing anxiety

Today, we have multiple options for therapies available with decades of study and evidence. Based on your anxiety type and what might work for you, your anxiety specialist can offer cognitive behavioral therapy (CBT) or exposure therapy.

The whole purpose of these therapies is so you can identify what you are feeling and how you can change your thoughts and behaviors to change how you feel.

Medications are also available for anxiety, but it is important to remember they do not cure it. They are only to help you operate better and focus better on your therapy.  Your doctor may prescribe medications like Selective Serotonin Reuptake Inhibitors (SSRIs) or Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs), depending on the severity of your anxiety.

Whether you take medication for anxiety or silent migraines, you must always consult a professional first.

Lifestyle changes

Together with professional help, you can try making a few lifestyle changes at your end.

• A good sleep is a must for both silent migraine and anxiety. So make sure to go to bed at the same time every day, even if it’s a holiday.

• For many people, skipping their meals can actually trigger a silent migraine, so if you’re that someone you might consider setting alarms on your phone to eat regularly.

• Practice certain deep breathing techniques, like the box breathing technique, for stress management. This can keep you from being anxious and further provoking migraines.

The purpose of managing these conditions is to stop them from taking up too much space in your life. Your consistent steps and professional support will not only help you manage silent migraine and anxiety, but also bring your body back in balance.

Giving Voice to a Silent Pain 

Just because the headache is missing does not mean you do not have a migraine. That and the constant weight of living with anxiety is not easy, but natural? Yes.

It is no ‘glitch’ that you are just imagining, it is certainly happening, and you certainly don’t have to go through this alone. Whether you feel the symptoms occurred only once or that they are not serious, you should not wait to figure things out on your own, especially when you can get clarity a lot quicker by talking to a neurologist right from your home through the best online psychiatry service platforms like GABA Telepsychiatry.

Your migraine might be silent, but you do not have to be. Speak up, seek clarity, and consult a specialist today.