Acephalgic migraine (also called acephalalgic migraine, migraine aura without headache, amigrainous migraine, isolated visual migraine and optical migraine) is a neurological syndrome. It is a relatively uncommon variant of migraine in which the patient may experience aura, nausea, photophobia, hemiparesis and other migraine symptoms but does not experience headache.[1] While it is generally classified as an event fulfilling the conditions of migraine with aura with no (or minimal) headache,[2][3] it is sometimes distinguished from visual-only migraine aura without headache, also called ocular migraine.[4]
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Acephalgic migraines can occur in individuals of any age.[5] Though there are some individuals—more commonly male—who only experience acephalgic migraine, frequently patients also experience migraine with headache.[6] Generally, the condition is more than twice as likely to occur in females than males.[7] Although not listed as such in the International Classification of Headache Disorders, 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.[8][9] Individuals who experience acephalgic migraines only in childhood are highly likely to develop typical migraines as they grow older.[10] Among women, incidents of acephalgic migraine increase during perimenopause.[7]
Scintillating scotoma is the most common symptom.[11] Also frequently reported is monocular blindness.[12] Acephalgic migraines typically do not persist more than a few hours and may last for as little as 15 seconds.[13] On rare occasions, they may continue for up to two days.[1]
Acephalgic migraines may resemble transient ischemic attacks or, when longer in duration, stroke.[1][14] The concurrence of other symptoms such as photophobia and nausea can help determining the proper diagnosis.[14] Occasionally, patients with acephalgic migraine are misdiagnosed as suffering epilepsy with visual seizures, but the reverse misdiagnosis is more common.[15]
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.