Facial metamorphopsia

In facial metamorphopsia, only faces appear to be distorted. Hécaen and Angelargues (1962) reported paroxysmal perceptual distortion restricted to faces in a series of 3 patients with migraine, whereas single case reports were provided by Curschmann (1916), Barolin (1972), Golden (1979) and Fuller et al. (1993). The following first-hand accounts can be added from migraine sufferers' postings to the Usenet Newsgroups or other Forums in the the internet.

Roger Corman's trash-movie "X" - The man with the X-Ray eyes, 1963. Some psychedelic effects produced by Ray Milland's X-Ray eyes whilst looking at other persons' faces are similar to those experienced in the visual illusion of facial metamorphopsia. © 2006 MGM (see here)

"I have suffered from migraines since I was 5 (I am now 40). When I was young they were always aura, headache, very acute numbness in my arm, tongue and teeth and then vomiting. In the recent couple of years they've become just aura with maybe just a tiny dull headache / no headache... Further to the above I should say that I have a very minor visual problem (migraine based) that has been with me for a few months now on and off. This may sound weird but when I look at someone's face, that person's mouth can appear a little strange for want of a better word!"

(David Thomas, Newsgroups: alt.support.headaches.migraine, Subject: Aura, June 11, 2002)

"actually, i just get what i call 'blinkers' - two large black flaps come down on either side of my face and my peripheral vision just disappears completely - and then that narrows into complete tunnel vision and it's fade to black. in between i get what i call the Picasso Effect, where people's eyes suddenly migrate to the same side of their noses when i look at them, or their mouths expand until the corners are nudging their ears, such stuff.

but if i once get the blinkers, it's over - it's into a dark room for three days with the blinds drawn and everyone being very quiet, dammit."

(Alma Hromic Deckert, Newsgroups: rec.arts.sf.composition, Subject: Book Lengths, September 25, 2003)

The recurring experiences of facial metamorphosia reported by Tom (who wrote: "I suffered from bad headaches/minor migraine when I was much younger (between 10 and 14 years old) but I've not suffered since", see here) are likely to represent episodes of migraine aura without headache.

"Generally the attacks manifest themselves in visual disortion. Objects I'm focusing on appear to change perspective massively and I 'feel' tiny in comparison. It often happens when I am watching TV or trying to concentrate on someone who is talking to me. Their head will appear to grow in proportion to their body until they look a little like one of those cartoon caricatures."

(Tom, Rikkus Alice in Wonderland forum, February 21, 2005)

"As I mentioned before, when looking at someone speaking, their head will seem to distort. Most often so it becomes larger than usual on their body, but occasionally they will get a 'pin head'. Quite often I will feel I can see lots of extra details I've never noticed before and sometimes it is like I'm actually 'seeing' their head and face in the right way for the first time (as if my usual non-AIWS vision is somehow an 'incorrect' perception)."

(Tom, Rikkus Alice in Wonderland forum, February 24, 2005)

"would seeing someone as having a really big ballon-like head count? When I was little I'd get this all the time, my parents or teachers would look as if they had really big heads and then it would switch to really small. I've never found an explanation and it never happens anymore."

(lil green, LiveJournal for Support Group for Migraine Sufferers, Subject: Distorted vision of human faces, February 4, 2006)

"Hello Dr. Podoll, While searching for an explanation for a phenomena I experienced during a scintillating scotoma event, I found an invitation on a web page to share this experience with you.

I call the leading edge of the scotoma the 'fire line' because to me it resembles the edge of a slow moving brush fire. It is definitely a series of straight lines arranged in angles but I think the CSD [cortical spreading depression] analogy of a brush fire going through my visual cortex is accurate. Pulsing and rotating yellow light emanates in front of a very black line. Blue and lesser red glowing light also emanate behind the predominately yellow glow. The black line is extremely thin and extremely black. Sometimes it disappears into an invisible edge between blocks of vision that are disjointed. Like a cracked lens that was poorly glued together. The whole arraignment moves, grows and spreads from a black comma shape that appears in the center of my vision. Trailing this edge it sometimes seems like grey clouds are blowing quickly away from the edge toward the opposite direction. As the SS [scintillating scotoma] courses to about halfway to one side of my vision. There seems to be about a five minute interval when I can see objects at both the center and the edges of the visual field. I still could not read but I thought it safe to go have a coffee break in a common area. That's when I noticed some perception problems.

Notably I was unable to 'see' one half of my own face in a mirror [hemianopic asthenopic scotoma(? hemianopica facial metamorphopsia?]. Moments later, I could see NO features of my own face. No matter what I did. My head appeared like a grey orb [asthenopic scotoma? facial metamorphopsia?]. It seemed like my mind was trying to prevent me from seeing the features of my own face. (Perhaps a protection mechanism?) A few minutes after that I was engaged in conversation with a coworker. It was very distracting as his face broke apart into floating components [facial metamorphopsia]. His eyes seemed exaggerated like a cartoon and would flip orientation. His mouth and nose were also distorted. His face (or rather its parts) seemed two dimensional like cut strips of photographs floating around. I later saw a cubist portrait that looked very much like what I experienced in real life. It was very hard to respond in polite conversation and I have no idea what we talked about. I just remember trying hard to act normal at the time.

I also noticed at this time that tables and chairs in the area in front of me seemed much much smaller than they should be [micropsia]. I was disoriented and worried that I may trip over them. These effects were transient and constantly changing. Also during this time, If I looked too long at an object like a cup on the table it seemed like I was suddenly very small and right next to it [microsomatognosia]. I have become very careful of what I look at now because the memory of these perceptions was frightening.

I've taken an interest in these episodes of late because they seem to be increasing in frequency and intensity. They started in my twenties perhaps once or twice every few years and now I am almost fifty they happen three times a month. This increase seems to coincide with a prescription for Atenolol that I started several years ago to control hypertension.

Also my mother and her sister have a history of epilepsy.

There seems to be two causes for these seizures that I can predict. One is stress and/or a significant emotional event or fright. The other is strenous work or sports workout followed by a hot shower. I rarely have but a light headache after the aura but often have a stiff, sore neck and one shoulder (never both) for the next few days.

I hope this account is of some help to others and I wouldn't mind continuing a correspondence about this with an interested expert in the field."

(K, E-Mail to Klaus Podoll, May 30, 2009)

In some cases, the visual effects of facial metamorphopsia may be mimicked by palinopsia, the persistence or reappearance of previously seen visual targets.

"I only get auras occasionally (seems to be only when I'm under emotional stress), but when I do they scare the hell out of me. I don't get the beautiful patterns..... I see full-on hallucinations. Usually of everything looking decayed and bloody.... probably has something to do with my job (I'm in forensics and paleopathology.... lots of corpses and skeletons), but there's nothing more disturbing than talking to someone you love and watching them rot while your head is throbbing. :::shudders:::"

(Raven, Newsgroups: alt.support.headaches.migraine, Subject: The Big Aura!!!, April 23, 2000)

References

Barolin GS. Psychology and neuropsychology in migraine. Res Clin Stud Headache 1972; 3: 126-153.
Curschmann H. Über einige seltene Formen der Migräne. Dtsch Z Nervenheilk 1916; 54: 184-205.
Fuller GN, Marshall A, Flint J, Lewis S, Wise RJS. Migraine madness: recurrent psychosis after migraine. J Neurol Neurosurg Psychiat 1993; 56: 416-418.
Golden GS. The Alice in Wonderland syndrome in juvenile migraine. Pediatrics 1979; 63: 517-519. Link to
Hécaen H, Angelargues R. Agnosia for faces (prosopagnosia). Arch Neurol 1962; 7: 92-100.
Podoll K, Robinson D. Migraine Art - The Migraine Experience from Within. North Atlantic Books, Berkeley, California 2009, p. 273-279.

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