When you hear the word migraine, you probably think of someone with a splitting headache, lying in a dark room. That is one type.

But there is another we are seeing more and more frequently: migraines with absolutely no head pain at all. Instead, they appear as psychiatric symptoms. And since they are not similar to the traditional migraines, they are left undiagnosed over the years.

Why This Matters

Migraines are among the major causes of disability among people who grapple with mental health issues.

Let’s discuss the aspect that changes everything. Depending on which area of the brain is affected, these migraines can actually cause cognitive or emotional problems without any accompanying headache.

The practical upside? Certain medications, many of them originally designed for heart health, can treat both the neurological and psychiatric aspects at once.

The Three Main Types

Classic Migraine

• Recurring headaches that pulse on one side of your head
• Usually comes with nausea or vomiting
• Disabling enough to interrupt your day
• Responds to standard preventive medications

Acephalgic Migraine

• No headache, but significant cognitive disturbance
• Episodes last for hours and get worse with stress
• Common symptoms: brain fog, feeling like you’re on autopilot, severe apathy, slow processing
• Sometimes includes visual changes or aura
• Affects the cortex, which is why the symptoms are cognitive rather than painful

Basilar Migraine

• Affects the brainstem and causes neurological symptoms
• Common signs: dizziness, fainting, vertigo, episodic neck tension
• Can trigger panic-like symptoms or even episodes that look like seizures
• Minimal or no headache

Treatment Options

For acephalgic migraine, angiotensin receptor blockers like candesartan and telmisartan have shown good results.

These medications help prevent migraines while also supporting cardiovascular and mental health.

For basilar migraine, calcium channel blockers such as verapamil and nimodipine can make a real difference. Research suggests they’re particularly helpful for people dealing with anxiety or bipolar disorder.

Why We Look at the Full Picture

This is where integrating neurology and psychiatry becomes so important.

At The Neuro Well, if someone’s been in treatment for anxiety or cognitive issues without much improvement, we start asking different questions.

• Could there be a neurological pattern we’re missing?
• Is this actually a migraine variant presenting as something else?

(Read more about why anxiety treatment sometimes doesn’t work.)

Older migraine treatments like valproic acid and topiramate often create psychiatric side effects. Not the best option if someone is already struggling with mental health symptoms or issues.

The newer CGRP medications avoid most of those issues, but they fail to deal with the psychiatric component of these types of migraine.

Having determined the exact subtype that is present, we will be able to select a treatment that addresses both neurological and psychiatric symptoms.

It is then that people get genuine relief.

If This Sounds Familiar

Perhaps you have been experiencing brain fog with no apparent explanation. Or periods of having a cognitive lapse. Or panic symptoms, which never really responded to conventional treatments.

Perhaps one might want to consider the possibility of a migraine variant being involved in what is happening.

The brain does not compartmentalize its problems. We should not as well.

When we look at the whole picture, which includes neurology and psychiatry, we tend to see the solutions that were right in front of our eyes all along.

Your symptoms are genuine, and they warrant a thorough evaluation.

Contact The Neuro Well today.

FAQs

Will regular migraine medications work for these variants?

Depends on the type. Regular migraine medication does not cover the psychiatric symptoms, hence the importance of knowing which variant it is.

Are these medications safe?

The drugs have been safely prescribed for decades to treat other forms of migraine and cardiovascular issues. They can provide extra health benefits in addition to preventing migraines.