Silent migraines
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Understanding Silent Migraines: Insights from Recent Research
Introduction to Silent Migraines
Silent migraines, also known as acephalgic migraines, are a type of migraine that presents without the typical headache. Instead, individuals may experience other migraine symptoms such as aura, visual disturbances, nausea, and sensitivity to light and sound. This article synthesizes recent research findings to provide a comprehensive understanding of silent migraines, their physiological basis, associated risks, and potential triggers.
Cortical Excitability and Silent Migraines
Central Neuronal Hyperexcitability
Research indicates that central neuronal hyperexcitability may predispose individuals to migraine attacks, including silent migraines. A study examining the cortical silent period (CSSP) using transcranial magnetic stimulation (TMS) found that patients with migraine with aura (MwA) exhibited a shortened CSSP compared to controls, suggesting reduced central inhibition and increased cortical excitability1. This heightened excitability could be a key factor in the susceptibility to silent migraines.
Sleep and Cortical Excitability
Insufficient sleep has been shown to alter cortical excitability, potentially influencing the occurrence of migraines. A study involving sleep restriction demonstrated that reduced sleep increased cortical excitability, particularly in the period leading up to a migraine attack7. This finding underscores the importance of adequate sleep in managing migraine susceptibility.
Structural Brain Changes and Silent Migraines
White Matter Abnormalities and Infarct-Like Lesions
Several studies have highlighted the association between migraines and structural brain changes. Migraine sufferers, especially those with aura, are at a higher risk of developing white matter abnormalities (WMAs) and silent infarct-like lesions (ILLs)3. These structural changes are more pronounced in individuals with frequent migraine attacks, suggesting a progressive component to the disease.
Silent Brain Infarcts
Population-based studies have found a significant prevalence of clinically silent brain infarcts in individuals with migraine with aura. These infarcts are often located in the posterior circulation territory of the brain, particularly the cerebellum2 10. The presence of these silent lesions raises concerns about the long-term neurological impact of migraines, even in the absence of headache.
Triggers and Behavioral Changes
Alcohol and Migraine Triggers
Behavioral changes, such as the avoidance of potential migraine triggers, are common among migraine sufferers. Alcohol is frequently reported as a trigger, with studies indicating that up to 21% of migraine patients identify alcohol as a precipitating factor4. However, the relationship between alcohol consumption and migraine attacks is complex and may be influenced by individual predispositions and other factors.
Preventive Measures
Given the potential for migraines to progress and the associated risks of silent brain lesions, there is a growing interest in preventive treatments. Preventive therapy may reduce the frequency and severity of migraine attacks, thereby decreasing the likelihood of structural brain changes and chronic migraine development2.
Conclusion
Silent migraines, characterized by the absence of headache but the presence of other migraine symptoms, are associated with increased cortical excitability and structural brain changes. Adequate sleep and the avoidance of known triggers like alcohol can help manage the condition. Preventive treatments may also play a crucial role in reducing the long-term impact of silent migraines. Further research is needed to fully understand the mechanisms underlying silent migraines and to develop effective management strategies.
Sources and full results
Most relevant research papers on this topic
The Cortical Silent Period is Shortened in Migraine with Aura
The shortened cortical stimulation silent period (CSSP) in migraine with aura patients suggests reduced central inhibition and increased cortical neuronal excitability, suggesting brain excitability may contribute to migraine attacks.
Non-RCT
Highly CitedMigraine and Silent Infarcts. Are we Making the Proper Decisions?
Migraine sufferers are at increased risk of silent brain lesions, and preventive treatment may help reduce the risk of chronic, refractory, and disabling migraines.
Migraine and structural changes in the brain
Migraine may be a risk factor for structural brain changes, particularly white matter abnormalities and infarct-like lesions.
Meta-Analysis
Very Rigorous JournalHighly CitedThe complex relationship between alcohol and migraine
Moderate alcohol consumption in patients with low migraine frequency may not be as harmful as previously thought, as the relationship between alcohol and migraine is more complex than previously thought.
Systematic Review
Rigorous JournalAura phenomena do not initiate migraine attacks—Findings from neuroimaging
Migraine attacks without aura are not initiated by aura phenomena, but rather by "silent" cortical spreading depolarization, which may activate trigeminal nociceptive neurons in subcortical regions.
Comparison of cortical excitability in chronic migraine (transformed migraine) and migraine without aura
Chronic migraine patients have a longer duration of cortical silent period, suggesting a possible difference in cortical excitability during transformation from migraine without aura to chronic migraine.
Non-RCTInsufficient sleep may alter cortical excitability near the migraine attack: A blinded TMS crossover study
Insufficient sleep before a migraine attack may cause dysfunction in cortical GABAergic inhibition, suggesting an increased need for sufficient sleep during migraine attacks to maintain normal neurological function.
RCTMigraine with aura and silent brain infarcts lack of mediation of patent foramen ovale
Migraine with aura is not associated with silent brain infarcts, and patent foramen ovale is not a potential underlying mechanism.
Observational StudyStructural and Functional Reorganization of the Brain in Migraine Without Aura
Migraine without aura is associated with reduced volume in the medial prefrontal cortex and decreased connectivity in various brain networks.
Observational StudyStroke and migraine linked by silent lesions
Cerebellar lesions are more common in migraine patients, particularly those with aura and frequent attacks, suggesting a potential link between migraine and stroke.
Observational Study