Curiouser and Curiouser: Alice in Wonderland Syndrome and Other Migraine Auras

Aura is the second of four possible migraine phases that may be experienced by a migraineur (the others are prodrome, the attack phase, and postdrome). It brings neurological symptoms and altered perceptions and signals that a migraine is going to start at any point within the next five minutes and two hours.

Although the symptoms of aura can be frightening, they are reversible and will usually go shortly after the onset of the migraine attack. In some, the aura disappears before the attack phase starts. Some migraineurs only experience the aura and no headache. Other migraineurs alternate between migraine with aura and migraine without aura.

There are several types of aura.

Alice in Wonderland Syndrome

This is a rare type of aura (most common in children, though it does occur in adults), named after the character created by Lewis Carroll and occasionally called Todd's Syndrome, after its discoverer. It occurs in 10 - 20% of migraineurs, but may only occur several times in the lives of many people.

Alice in Wonderland Syndrome causes distortion in perception. Things (even body parts) may seem larger or smaller, or closer or further away (this is called macropsia and micropsia respectively). Time, sound, and touch may all be distorted. The migraineur can even experience hallucinations (which may include feeling that fixed objects are moving).

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Alice in Wonderland Syndrome is often unreported.

• Children may not realise that what they're experiencing is unusual, and so not mention it to anyone.
• Adults who experience it fear being misdiagnosed as psychotic, or otherwise mentally-ill, and so keep it to themselves.

No definitive treatment has been found, although - for the few people who experience Alice in Wonderland Syndrome regularly - some positive effects have been achieved by preventative treatment with anticonvulsants (Topiramate) or antidepressants (Amitriptyline).

Visual Aura

Visual aura is the most common type of aura. However, "visual aura" is actually a very broad term for what may be one of a great many symptoms.

A 1992 study found that:

• 81% had blind spots,
• 77% saw spots of flickering light,
• 21% experienced double vision.

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Other common visual auras are: blurred or cloudy vision; haloes of light; flashes of light; patterns such as wavy lines, stripes or graphs; and loss of peripheral vision.

Sensory Aura

Not all aura are alike. Sometimes aura can cause strange sensations.

According to a 1996 study, these are the locations and sensations migraineurs are most likely to feel with sensory aura:

• 96% had strange sensations in the hand
• 84% had pain on the side of the head 
• 78% had odd feelings in the arm
• 67% had strange feelings, perhaps numb, face
• 62% had strange sensations in the tongue
• 24% had odd sensations in the foot
• 24% had sensations in the leg
• 18% had strange sensations in the whole body

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Sensory Aura is not commonly thought-of, even by doctors, when we think about migraine. Thus, it's easy to overlook them. Even to mistake them for something far worse, such as a heart attack or stroke

Though these sensations may be frightening, they will pass with the aura, and they are nothing to be afraid of.