Can you have a migraine without a headache?

By Midrand Medical Centre
Woman experiencing dizziness and imbalance associated with vestibular migraine


Imagine feeling as though the room has shifted, the supermarket aisle is moving beneath you, or a short car journey suddenly makes you nauseous — yet your head does not hurt. Migraine may not be the first thing that comes to mind, but head pain is not compulsory in every migraine disorder.

One important example is vestibular migraine, where dizziness, vertigo, imbalance and motion sensitivity can take centre stage. There is also a recognised form of migraine aura that can occur without a subsequent headache.

Migraine is bigger than headache

Migraine is a neurological disorder, not simply a particularly bad headache. Head pain is common, but migraine can also affect vision, balance, sensory processing, concentration, the digestive system and sensitivity to light, sound and movement.

Some people experience a typical migraine aura without any headache afterwards.

Aura symptoms can include temporary visual changes, tingling or sensory changes and difficulty with speech or language. Doctors call this typical aura without headache.

The phrase “silent migraine” is sometimes used informally, but it can mean different things to different people. It is more useful to describe the actual symptoms and pattern so that the correct migraine subtype — or another cause entirely — can be considered.

What vestibular migraine can feel like

The vestibular system helps the brain understand movement and maintain balance. When migraine affects this system, symptoms can include:

  • a spinning sensation or vertigo
  • a feeling of rocking, swaying or moving when you are still
  • unsteadiness or imbalance
  • dizziness triggered by moving the head
  • nausea with movement
  • dizziness in visually busy environments
  • sensitivity to light or sound
  • visual aura in some attacks
  • motion sensitivity, including travel sickness.

A person may have head pain during some attacks and no headache during others. That absence of pain does not automatically rule vestibular migraine out.

Visually busy places can be particularly interesting. Supermarket aisles, scrolling screens, crowds, patterned floors or watching fast-moving traffic may provoke symptoms because the brain is having to process a large amount of visual movement while maintaining balance.

How do doctors recognise vestibular migraine?

There is no single blood test or brain scan that proves someone has vestibular migraine.

Diagnosis is based largely on the pattern of symptoms, migraine history and exclusion of another condition that would explain the episodes better.

Under the internationally recognised diagnostic criteria, vestibular migraine involves repeated episodes of moderate or severe vestibular symptoms lasting between about five minutes and 72 hours.

A person must also have a current or previous history of migraine, and at least half of the vestibular episodes are associated with a migraine feature.

That feature does not have to be headache. It can instead be sensitivity to both light and sound or a visual aura.

This is one reason vestibular migraine can be overlooked in people who associate the word “migraine” only with severe head pain.

Dizziness has many possible causes

Dizziness is one of those symptoms that can mean very different things.

Benign paroxysmal positional vertigo (BPPV), inner-ear conditions, medication effects, blood-pressure changes and several neurological or cardiovascular conditions can all produce dizziness or imbalance.

Ménière's disease and vestibular migraine can also overlap in some of their symptoms. A careful history of hearing changes, duration of attacks, triggers and accompanying migraine features can help separate them.

This is why recurring unexplained vertigo should not simply be labelled “migraine” without an assessment — especially if the pattern is new or changing.

New neurological symptoms need particular care.

Seek urgent medical attention for sudden dizziness or headache accompanied by symptoms such as new weakness or numbness on one side, facial drooping, difficulty speaking, confusion, collapse, severe difficulty walking, persistent double vision or a sudden severe headache unlike your usual headaches.

A first-ever aura later in life, or an aura that is very different from your usual pattern, should also be medically assessed because other conditions can sometimes mimic migraine.

What can help vestibular migraine?

Treatment is individual. The first useful step is often identifying the pattern.

A symptom diary can record when an episode started, how long it lasted, dizziness or vertigo symptoms, nausea, head pain if present, menstrual timing, sleep, meals and possible triggers.

Regular sleep, sufficient hydration, consistent meals, appropriate exercise and managing individual migraine triggers may form part of a treatment plan.

Some people need medication for attacks, while those with frequent or disabling episodes may benefit from preventive migraine treatment.

Vestibular rehabilitation may also help selected people, particularly when persistent imbalance or motion sensitivity continues between attacks.

Newer migraine therapies, including medicines targeting the CGRP pathway, are also being studied and used in selected patients, although the evidence base for vestibular migraine continues to develop.

The important part is not to keep guessing. Recurrent dizziness deserves an explanation, particularly when it is affecting driving, work, exercise or your confidence moving through everyday spaces.

If dizziness, imbalance or nausea keeps returning — with or without a headache — an MMC GP can help explore possible causes and decide whether further assessment is needed. Call Midrand Medical Centre on 011 315 2512 to schedule an appointment.

Sources

  • International Headache Society. International Classification of Headache Disorders (ICHD-3): Vestibular migraine.
  • International Headache Society. Typical aura without headache.
  • Bárány Society and International Headache Society. Vestibular migraine: Diagnostic criteria – Consensus update. Journal of Vestibular Research.
  • Vestibular Migraine: A Systematic Literature Search and Narrative Review of Diagnostic Criteria, Pathophysiology, Differential Diagnosis, and Treatment Approaches. 2026.
  • Insights into Vestibular Migraine: Diagnostic Challenges, Differential Spectrum and Therapeutic Horizons. 2025.
  • Vestibular migraine: an update. 2024.
Location: Shop 1, The Emporium Corner Church and, Market St, Halfway House, Midrand, 1685, South Africa

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