Living with silent migraines: a strangely beautiful neurovascular complaint
I was a law student in London when I first experienced a silent migraine. Where I was or what I was doing I can no longer say, but I do recall being quite frightened by the visual effects. I wondered whether I might be having a stroke and thought about calling a doctor. In the end, I decided that this was unlikely and took a lie down instead. Sure enough — the symptoms cleared after about 40 minutes and I was able to carry on as normal.
Some time later, I talked to my parents about it on the phone. And found some kind of reassurance: my maternal grandmother used to have these episodes too. A bit of research told me that they are kind of a migraine but without the pain. Unpleasant, but most likely nothing to worry about. Just try and take it easy when they hit and let them pass.
Getting to know my aura
Over the years that followed, the silent migraines would return every now and again. The symptoms were always the same.
Suddenly, I would notice a blind spot in the centre of my field of vision, making it hard to read or focus properly. Pretty soon afterwards, the zigzags appear. This visual disturbance called a “migraine aura” and is common among suffers of both normal and silent migraines.
Mine always have the same pattern: a series of zigzag lines curling around the top left of my field of vision. They start off small and then expand over the next 10–15 minutes until they significantly impair my vision. These strange patterns are mostly gold-silver and black — shimmering, flickering and flashing. There is a strange, quite ethereal beauty to them.
Coping with silent migraines
However, the visual disturbance can be anxiety-inducing. If I’m not at home or able to just sit and relax when one of my “episodes” strikes, the loss of control can be stressful. For a while, you are at the mercy of your own body and brain — just a passenger in a car which is doing its own thing. Being in this condition while out in a city full of noise and strangers is highly unpleasant.
Mostly, I am able to carry on doing some kind of work during the episode. However, things that demand complete focus (both in terms of mental and visual acuity) should be avoided. Riding my bike through traffic or highly concentrated work? I’ll be leaving those activities alone until the episode is over, thanks!
The auras of silent migraines tend to go on for 30–45 minutes before disappearing. Not without trace, though — there is a kind of “hangover” effect which can last for up to a day afterwards. The zigzags’ going-away presents to me include: low-level nausea, a dull or stuffy feeling in my head that only goes away after a good night’s sleep and even slight disorientation. It’s like my brain isn’t quite in control of my body.
I can’t afford to take a whole day off and go to bed every time I get these things. But they do force me into a lower gear for a while.
What the doctor said
After a sudden increase in the frequency of the zigzags’ visits about 10 years ago, I finally went to a neurologist. I wanted to rule out any serious underlying causes and check whether any meds or treatment were necessary.
After a quite dramatic-looking experiment using what looked like a swimming hat with hundreds of wires coming out of it, the specialist told me that certain parts of my brain seemed a bit over-excitable. I could have told him that without the swimming hat! Fundamentally, though, I had nothing to worry about.
No one really knows what causes (silent) migraines. Supposedly, they are the result of certain chemical, hormonal and blood flow changes within the brain. Sufferers mostly have their own “triggers”. Going forward, the doctor advised me to monitor when these silent migraines were occurring and, if possible, identify any things which set them off. Perhaps then I could actively avoid episodes in the future.
Finding the triggers
It was good to know that I wasn’t going to drop dead and that I wasn’t seriously ill. The risk of stroke is supposed to be slightly higher for migraine sufferers who get auras. However, other risk factors (e.g. high blood pressure) are far more significant, putting the migraine aura-risk in perspective. And getting on with life, managing my own minor problems — that sounded doable! I just needed to find those triggers…
I’d already noticed that silent migraines tend to occur when I am under strain or am experiencing some kind of emotional turmoil. Indeed, the increased incidence which drove me to seek medical advice coincided with a period of considerable and sustained stress in both my personal and professional life. That is clearly fertile ground for silent migraines to occur.
Once that foundation is in place, another trigger is all it needs. Quick changes in light conditions are definitely risky for me. Looking from a dark plane cabin out into the brightness of the sky outside, for example, or glancing at a bright light in an otherwise dark surrounding. The contrast seems to be the key element.
Every now and again, I still get a visit from my old friends, the zigzags. I certainly don’t enjoy the experience, but they are such a part of my life now that it is far better to try and accept them as they happen than to resist or get upset. Rather than get worked up about the loss of control, simply go with the flow and work around the physical and mental impairment. This too will pass.
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