Complex visual hallucinations

Complex hallucinations, i.e. any recognizable imagery such as the examples given by Siegel and Jarvik (1975), must be distinguished from elementary hallucinations of geometric imagery that may be interpreted by the experient as a person or humanlike form, an animal or animallike creature, an object or other animate or inanimate entities. This is exemplified by the following reports of migraine sufferers who likened the appearance of their scintillating scotomas to the "shimmering alien" from the Sci-Fi TV series Star Trek or to the "form of a person", respectively.

"I've had a chocolate induced migraine, but it was only after I had eaten more chocolate in one sitting than any smart person would attempt... As for the silvery 'blind' spots, they are usually right in the center of my field of vision (they remind me of that shimmering alien in an old Star Trek). When the alien appears, I know to go lie down in a dark, quiet place."

(Brynn Robins, Newsgroups: rec.crafts.textiles.needlework, Subject: Re: OT: migraines/Tripping over your tongue..., September 26, 1997)

"But I always have some weird visual thing going on, even when I don't get the complete aura. I describe it as 'seeing air.' The air is full of sparkling dots, like I can see the molecules colliding.... now *that* is pretty, especially when they form dense shapes (like the form of a person) even when there's nothing there. I used to think everyone could see this.....but I've come to realize that only other migraineurs see them...."

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

In contrast to such mere interpretations of abstract geometric imagery as recognizable objects of the visual world, proper complex hallucinations are experienced as perceptions of such entities without external stimulus. A particularly interesting type of such complex hallucinations is autoscopy, the vision of one's own body (Lukianowicz, 1958), which may occur in different varieties as visual migraine aura symptom (Lippman, 1953).

Autoscopic phenomena

An autoscopic hallucination is the purely visual impression of seeing one's own body (or parts of it) as if being reflected in a mirror (Brugger et al., 1997). This mirror image of oneself can be motionless or, more commonly, imitate one's own movements, gestures or facial expressions. This feature is well described in the two following observations of autoscopic hallucinations from migraine sufferers where the autoscopic doubles are "walking alongside" or "copying every movement", respectively.

"The Swedish botanist Carolus Linnaeus suffered from migraines, and prior to an attack, he would notice someone walking alongside of him. Once he entered a lecture room to teach a class, but he saw someone standing at the lectern. Thinking that he arrived too early, he left, only to realize that he was looking at a spectral illusion of himself. This is a common manifestation of migraines in Scandinavian countries, and it is called 'autoscopic hallucinations.' People also call them 'doppelgangers' and they are responsible for a whole class of ghost stories."

(Cited from Gary Lockhart: Migraine Headaches; in: Natural Earth: The English Standard Reference on Herbal Healing - Volume 1: The Herbal Center of Healing, November 6, 2003)

"Edward Podlasky, in 'Fate' magazine, recounted the story of a Chicagoan migraine sufferer, Harold, who encountered his doppelganger on several occasions whilst suffering migraine attacks."

(Geof Downton, THE BRITISH FAIRY TRADITION: FROM THE BRONZE AGE TO TINKERBELL, November 24, 2004)

In addition to mere visual impressions as previously described for autoscopic hallucinations, heautoscopy proper (Brugger et al., 1997) involves somaesthetic or vestibular sensations or both. Thus, the hallucinatory mirror image is felt to be one's own double. The scarce information provided in the two previous case reports of Linnaeus and Harold of Chicago leaves it open whether this criterion was fulfilled or not, so it's safe to consider them as examples of autoscopic hallucinations rather than heautoscopia proper. To the best of our knowledge, the latter variety of autoscopic phenomena has not yet been documented as a migraine aura symptom, although it is probable that there are many migraine sufferers out there in the cyberspace who have experienced this amazing "hallucination of the self" (Lhermitte, 1951) – if you wish to communicate your experiences, you are welcome!

Giving an account of a typical out-of-body experience (OBE), which represents yet another variety of autoscopic phenomena according to the classification of Peter Brugger and colleagues from the University Hospital Zurich, Switzerland, the experient never reports seeing his or her mirror image or double, but rather one's own body from outside. In a Usenet Newsgroups discussion from 1992, Marvin Minsky, migraineur from teenage years on and former director of the famous MIT Artificial Intelligence Laboratory, recalled an episode of a typical OBE at age 17. Further reports from the internet are collected on our separate webpage devoted to observations of OBEs from migraine sufferers.

Migraine Art: Autoscopy. © 2007 Migraine Action Association and Boehringer Ingelheim Limited

In a study by Podoll and Robinson (1999) assessing the "collection of 562 migraine art pictures, seven pieces illustrate various elements of out-of-body experiences (OBEs) and related phenomena, including the somesthetic sensations of a duplicate or parasomatic body and the visual experiences of perceiving the own body, i.e. autoscopy, and its environment from a vantage point out of the body. Phenomenological features of the OBEs depicted are compared with 17 similar case reports reviewed from the literature. It is concluded that OBEs can occur as migraine aura symptom, which supports the notion that OBEs represent a preformed functional response of the brain. This neuropsychological theory supplements existing psychological theories of OBEs, which consider the said phenomena as representing hallucinatory experiences based on imagination and memory" (p. 886).

Complex hallucinations of human beings

"I was diagnosed with Classic Migraines at age 8, I was having several a day when they first started. I had visions with them. Went through all the brain scans and they diagnosed me. The doctors told my Mom that seeing visions was not too out of the ordinary with Classic Migraines. My mom went and found a book at our local library (I don't remember the name. That was almost 20 years ago.) It told about documented cases of people having visions with the migraines. It said a majority of the people see God or Angels. It also said that Joan of Arc's symptoms when she had her visions were very similar to Classic Migraines. ...

I never saw God or Angels. I saw a variety of things. Used to see a person walking through streamers in a dark room, and then for a while I saw a little green man on a purple elephant. Weird, huh? I don't recall the others right off hand.

A person I know via internet just had her very first experience with a vision followed by a migraine. She saw a yellow car being hit by a train in her town. Shortly after she happened to be driving that way and saw emergency vehicles at the tracks and a smashed up yellow car. She's having a rough time of it.....

Hope I didn't rattle on too much."

(kittyhm, SciFi.com BBoard, Lost webpage, August 11, 2001 / March 9, 2004) [more]

"I have hallucinations about 5 times a week ususally during the night, occasionally during the day. What I see varies: geometric patterns, a bright light, images of objects or people. Each hallucination lasts for only a few seconds, but here will be many of them in a row. My eyes are closed during these! If they are extra vivid, I'm in for a migraine. I'm trying low doses of dilantin to try and stop these."

(Richard, Newsgroups: alt.support.headaches.migraine, Subject: Creativity during migraine, December 29, 1996)

"As requested on the Migraine Aura Foundation site I am submitting to you my experience with migraine aura. I am now a 53 year old female and have been experiencing this type of aura for 20 plus years. Typically the aura goes something like this: I see or 'remember' a person within my minds eye who is as familiar to me as the back of my hand. My brain 'blooms' with the sensation - it is as violent and shattering as a sneeze but occurs, of course, within my brain. It feels as if I have reviewed this profound scene in front of me a billion times. Then my entire body becomes involved - the energy moves down to my stomach resulting in nausea, a feeling of extreme anxiety and dread passes over me and I begin to sweat. At this point the visual/metal picture is fading from my consciousness as I cope with the physical symptoms. All of this lasts about 15 seconds. When the aura completely passes I can not remember what I was viewing which is bizzare considering that 30 seconds ago it was more familiar to me than anything else in the entire world. If I can afford to nap afterwards all after effects are erased. However if I cannot sleep there is some mild confusion for about 10 minutes. The next day when I think about the experience it seems like my memory is recalling a dream. There is no dreamlike quality about it but it is as if I were looking at myself through the eyes of someone else. This part is extremely difficult to put into words. The best description I can think of is the feeling a person can get when they walk into their home after an extended time away. You are familiar with your surroundings yet, because you have been exposed to other environments, home feels different. Then multiply this feeling times 10. I can 'feel' for days when one of the auras is circling me - like a shark swimming around its prey. I cannot control when and where these occur. Sometimes I get a headache the next day and sometimes not (I have had migraines my entire life). If I do not get a headache the day after an aura I have more energy and clarity of mind. When I first began to experience the auras I would see the Virgin Mary holding Christ as an infant and the shape of the square was very predominant and important within the aura. The very first déjè vu aura I ever had involved a triangle that felt like it emminated away from me with the point facing out and I was in the middle of the base. This never occured again. The visual part of what I see has changed over the years but I don't try to remember the symbols anymore. I have tried writing them down as they occur but cannot make sense of nor relate to what I have written. If I am with people when an aura begins a person within my immediate environment becomes inserted into the aura as it plays out. These experiences typically occur when I am performing a task within my day that is familiar to me. They have sometimes occured while falling asleep and once an aura happened within a dream during the middle of the night."

(Cynthia, Email to Klaus Podoll, November 11, 2007)

Lilliputian hallucinations

"Once I thought it was snowing ashes for about 10 seconds, and it took almost 5 seconds to figure out it was my vision - and that was actually after the pain had subsided, which is totally out of the ordinary. Personally if I ever saw a purple leprechaun dancing with a green rabbit I'ld probably attribute it to migraine aura. I've just had my vision do too many crazy things during migraine aura to ever suspect anything else anymore."

(Heather, Newsgroups: alt.support.headaches.migraine, Subject: Migraine Aura (Quick Sparks), September 7, 2003)

"I was diagnosed with Classic Migraines at age 8 ... I had visions with them... and then for a while I saw a little green man on a purple elephant. Weird, huh?"

(kittyhm, SciFi.com BBoard, Lost webpage , August 11, 2001 / March 9, 2004) [more]

"But Hustvedt was an unusually sensitive child, who suffered from migraine, visual spots and lights, and even hallucinations, what she calls, 'my nerves and strangenesses'. She describes experiencing a Lilliputian hallucination: 'I saw these two little figures on the floor, a little man and a little ox, so weird. Pink. And when I was having it I believed that they were there, but I wasn't afraid of them. They had a nice, friendly feel. Which is also part of it."

(Cited from Article Darkness and Light © 2003 Telegraph Group Limited, November 10, 2003)

References

Brugger P, Regard M, Landis T. Illusory reduplication of one's own body: Phenomenology and classification of autoscopic phenomena. Cognitive Neuropsychiatry 1997; 2: 19-38.
Lhermitte J. Visual hallucinations of the self. Br Med J 1951; 4704: 431-434.
Lippman CW. Hallucinations of physical duality in migraine. J Nerv Ment Dis 1953; 117: 345-350.
Lukianowicz N. Autoscopic phenomena. AMA Arch Neurol Psychiatry 1958; 80: 199-220.
Minsky M. Society of mind. Simon & Schuster, New York 1986.
Podoll K, Robinson D. Out-of-body experiences and related phenomena in migraine art. Cephalalgia 1999; 19: 886-896.
Podoll K, Robinson D. Recurrent Lilliputian hallucinations as visual aura symptom in migraine. Cephalalgia 2001; 21: 990-992.
Podoll K, Robinson D. Migraine Art - The migraine experience from within. Neurol Psychiat Brain Res 2002; 10: 29-34.
Podoll K, Robinson D, Nicola U. Le allucinazioni lillipuziane nell'arte emicranica. [Lilliputian hallucinations in Migraine Art. In Italian] Confinia Cephalalgica 2002; 11: 127-132.
Siegel RK, Jarvik M. Drug-induced hallucinations in animals and man. In: Siegel R, West L (eds) Hallucinations: Behavior, experience, and theory. John Wiley and Sons, New York, NY 1975, 81-161.
Spencer J, Spencer A. The encyclopedia of ghosts and spirits. Headline Book Publishing, London 1992.

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