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.

More About Aura and What Can Be Done

Aphasia in Aura

Migraineurs can have difficulty with speech in the aura phase with slurring, putting sentences together, or remembering words. If you have these problems, they will affect both speaking and writing.

Weakness or Paralysis

If you suffer hemiplegic migraine, you may suffer weakness or even temporary paralysis on one side of your body. Although it's very frightening, and feels a lot like having a stroke, these effects are temporary. The headache may be absent in hemiplegic migraine. That said, this type of migraine is relatively rare, and you should check these symptoms with your own doctor.

A Word About Allodynia

Allodynia (where you have hypersensitivity to light touch, especially on the scalp or forehead) is not classed as aura, being felt throughout the migraine (especially in migraineurs with other chronic pain conditions). However it can occur in the aura phase. Dihydroergotamine has shown to be effective.

Migraines with Aura and Strokes

Recent research has shown that some migraineurs are at an increased risk of stroke. This risk of ischaemic stroke is particularly raised in women aged 35 to 45, who experienced aura with or without migraine, who used oral contraceptives, or who smoke. There is a relative increased risk of ischaemic stroke in young women, but the risk remains small since the risk of stroke is so tiny in young people to begin with.

A 1997 study found that the figures for stoke for women aged under 35 (a year) are:

• 1.3 women per 100,000 have stroke who do not have migraine and do not take the contraceptive Pill
• 5 women per 100,00 have stroke who don't have migraine and do take the contraceptive Pill
• 4 women per 100,000 have stoke who have migraine without aura and do not take the contraceptive Pill
• 8 women per 100,000 have stroke who have migraine with aura and do not take the contraceptive Pill
• 14 women per 100,000 have stroke who have migraine without aura and do take the contraceptive Pill
• 28 women per 100,000 have stroke who have migraine with aura and do take the contraceptive Pill

As you can see, the figures are substantially higher in women who have migraine. That said, studies show 167 women per 100,000 women every year die from a smoking-related health problem, so migraineurs should not panic about stroke, even if they take the contraceptive pill.

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What is the connection?

No-one is quite sure. Hole in the heart has been found in some, but not all, patients with migraine with aura. Some recent studies suggest the blood of migraineurs with aura is more likely to clot, which might raise the risk of a cardiovascular event. Some suggest there might be vascular differences in migraineurs who experience aura. Research is still continuing.

Do B Vitamins Help?

Some research suggests that migraine with aura is a risk factor for high levels of Homocysteine, a risk factor for stroke. Although that isn't the whole story, the good news is that there's a very simple step for lowering for Homocysteine levels: take B12, B6 and Folic Acid.

Australian researchers gave half their participants vitamin supplements (2mg Folic Acid, 25mg of 66, and 400mcg of B12) and half of their participants a placebo. They found that the participants who took supplements lowered their Homocysteine levels (which meant, possibly, a lower risk of stroke), and also had fewer migraines. That has to be worth trying!

Try supplements, or pack your diet full of these vitamin-packed foods:

Folic Acid: Lentils, beans, peas, nuts, green leafy veggies, and citrus fruits.

Vitamin B6: Pork, poultry, oatmeal, brown rice, and eggs.

Vitamin B12: Sardines, beef, tuna, cheese, eggs, and salmon.

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Talk to your doctor

Your doctor can prescribe a preventative. An appropriate preventative today may make your aura symptoms better in the future.

Improve Your Nervous System

Take some supplements to improve your nerve health. Omega 3 fish oil, Magnesium (400mg), Vitamin B2 (150-400mg) and Co-enzyme Q10 (150mg) a day are all thought to improve nerve health.

Relax

Getting into a calmer, more relaxed frame of mind with calming daily walks, deep breathing, yoga, meditation, or Tai Chi may help reduce your future incidences of migraines.

Carry your migraine abortive

And take it right at the start of the attack phase (as soon as the headache starts). Research shows that migraine abortive medications work more effectively if they are taken right at the start of the attack.