What Is An Acephalgic Migraine?

QUESTION:

Dear Dr. Heller,

I was searching the Internet via Yahoo and your link was the first to come up under the search for "acephalgic migraine".  Upon launching your site, I found no information regarding this specific request for information.  I had an episode on July 3rd that was diagnosed as a stroke or TIA.  I saw an article describing an acephalgic migraine.  The description is exactly what I experienced.  An MRI at the time of the episode showed a small mark or "event" on my brain.  Within 18 hours I was fully back to normal and to date have no effects or side effects.

What is the difference between an acephalgic migraine and a stroke/TIA?  Might what have occurred be an acephalgic migraine and not a stroke/TIA?  I am a healthy 39 year old male who does not (never have) smoke, is 5 feet 9 inches tall, weighing 165 pounds and exercises regularly.  I am just searching for answers as all of the doctors I've met with are shocked at this occurrence based on my age and clean lifestyle.

ANSWER:

An acephalgic migraine means a migraine without headache.  The most common is vision related.  A migraine should have a normal MRI.

A TIA is a temporary stroke that clears up.  That your MRI showed a problem that cleared up implies a TIA or stroke.  You should at minimum have your carotid arteries checked, an echocardiogram performed, and labs to include a sed rate, lipid profile, CBC with platelets, and thyroid profile, and possibly a c-reactive protein and homocysteine level.