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Ask the Expert: Migraine Without the Headache

Q. I was diagnosed with migraine many years ago. Recently, I was told that I have transformed migraine. I don’t have to have the headache, just a “flicker in my vision” and I suddenly feel terrible as if I’m going to collapse, pass out or worse. I have had every cardiac, allergy and neurological work-up.

A. We usually use the term transformed migraines to describe headaches that began with all the characteristics of typical, intermittent migraines, but now are occurring daily or near daily in a milder but more persistent form. That does not seem to be what you are describing.

I think what you are describing is a migraine equivalent or migraine aura without headache. In this case, you get all the symptoms of a migraine, starting with an aura and ending with the nausea or other associated symptoms, but don’t get the throbbing headache.

Since there is no pain, treating these episodes with a migraine-specific pain reliever would probably not be helpful. Instead, the best way to treat these episodes is to use a preventive medication that you take every day. The same medications used to prevent migraines should be helpful in preventing this as well, but it will be a trial-and-error process to find one that works for you.

Susan M. Rubin, MD
Women’s Neurology Center
Glenbrook Hospital
Glenbrook, IL

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