Migraine affects approximately 39 million people in the United States, including children. Migraine isn’t just a headache — it’s a neurological condition with unique symptoms.
Migraine is the third most common medical condition in the world. Migraine episodes involve a throbbing pain sometimes paired with aura symptoms, which include:
- trouble speaking
- numbness or tingling
- vision changes
Some people also report different kinds of auras. Hallucinations, however, are different from auras, and they’re
Visual auras don’t usually involve seeing things that your brain makes up. More commonly, they’re visual disturbances caused by over-excitability of their occipital cortex.
Some people who have migraine have sensory disturbances, but they’re likely not hallucinations. Hallucinations are sensory experiences that can seem real but are actually created by your mind.
Visual auras are relatively common and can include various sensory disturbances like visual patterns or lights. Knowing what can occur with a migraine attack can help you recognize what’s going on.
Visual auras are the most common type of aura. Symptoms of visual aura can include:
- jagged flashes of light or bright spots
- zigzag lines or geometric shapes in your vision
- some vision loss or blind spots
While simple visual auras are typically seen with migraine, complex visual hallucinations, like those of fully formed people or animals, can occur with basilar migraine or familial hemiplegic migraine.
Complex visual hallucinations with hemiplegic migraine usually appear in a late stage of the migraine attack and can last hours or days.
In migraine, visual hallucinations occur because the visual cortex in the brain is stimulated or because the connections between nerve cells are damaged. This can occur in migraine as an aura.
In a study that looked at auditory hallucinations and migraine, the
Sensitivity to smell is common in those who live with migraine, affecting around 95 percent of people with the condition.
During a migraine attack, olfactory hallucinations can also occur. These are much more rare, and during these hallucinations the person smells specific things that those around them don’t smell. The smells are also associated with the headaches. The smells typically occur before or during a migraine attack.
Olfactory hallucinations with migraine occur in approximately 0.1 percent of adults with migraine.
In one study, most people with olfactory hallucinations associated with migraine had migraine without aura and less than 15 headache days monthly. All of them had sensitivity to light and sound with their migraine attacks. This was a small study, and more research is needed.
While the specific smells can vary among people, the smells can be either undesirable or pleasant. There’s no one specific kind of olfactory hallucination associated with migraine.
If you have hallucinations with your migraine attacks, make an appointment with a doctor. They’ll talk with you about your symptoms, do a physical exam, and order tests to rule out any other potential causes of the hallucinations.
They might order a blood or urine test as well as any imaging tests like a brain MRI.
They’ll be able to determine whether the hallucinations are part of an aura or are a symptom of another medical issue. Once the underlying cause of the hallucinations is found, appropriate treatment can be given.
If the hallucinations are determined to be part of an aura, your doctor will go over the best ways to help treat aura symptoms and how to minimize them. This may include:
- putting a cold compress on your forehead or the back of your neck
- going into a dark, quiet room to lie down and close your eyes
- taking medication, for both prevention and treatment
Prevention medications that may be used if the hallucinations are part of the aura include:
- antidepressants like amitriptyline
- blood pressure medications like beta-blockers
- botulinum toxin (Botox)
- anti-seizure drugs like topiramate
- calcitonin gene-related peptide (CGRP) antagonists
Medications for treatment of the migraine and aura can help reduce the severity of symptoms once they are occurring. The sooner you take the medication, the more effective it is. These medications can include:
- over-the-counter pain relievers like acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
- triptans like rizatriptan or sumatriptan
- anti-nausea medication
- gepants and ditans, two newer therapies that target receptors and sensory nerves
Sometimes hallucinations can occur with migraine, often with aura. These hallucinations can be visual, auditory, or olfactory.
If you have any hallucinations with migraine or even after the migraine has resolved, tell your doctor. They can do an exam and order any necessary tests to determine the underlying cause and help you get the appropriate treatment.
If the hallucinations are associated with aura, there’s treatment available to manage them. You and your doctor can work together to find the most effective treatment for your symptoms.