Persistent aura symptoms and dreaming

ChelleWMCN [subject #272], Flashes, 2007. "I have had nightmares/dreams of someone taking flash photographs of me only to awaken to the same flashes in my darkened room. This is what I see when I say I see flashes." © 2007 ChelleWMCN (see here)

Just as transitory migraine aura symptoms can be experienced whilst dreaming (see here), so can persistent migraine aura symptoms. This is documented by the testimony from 8 subjects (#23, #138, #172, #189, #318, #382, #405, #515, #555, #558) who got a diagnosis of definite persistent aura without infarction in this study based on Sofia Greene's internet survey. Six subjects (#86, #230, #234, #320, #405, #515) explicitly stated that they never experienced persistent aura symptoms in dreams, although worries and concerns related to the illness may have crept into the manifest dream content (subjects #234, #320).

Addressing the question whether subjects with persistent aura dream about their intact vision, as before the onset of persistent aura, or about the disturbed vision, and whether the dream content was a function of time since the onset of persistent aura and type of persistent aura, one finds that 6 dreamers (#86, #230, #234, #320, #405, #515) reported dreams about intact vision although the mean time that elapsed since the onset of persistent aura was several years. There is no clear relation with the type of persistent aura. These results gives modest evidence for the existence of a basic neural representation of the visual world that is relatively insensitive for changes in the sensory input. The findings resemble clinical observations in limb amputees who experience dramatic disturbances of the integrity of the body rather than the visual world. A majority of amputees continue to experience a normally-limbed body during their night dreams, which has similarly been interpreted as a failure of the body schema to adapt to the new body shape, giving modest evidence for the existence of a basic neural representation of the body that is relatively insensitive for changes in the sensory input (Mulder et al., 2007).

mel07green [subject #382], Dream image of eye doctor's ophthalmoscopic view into my eye with cartoon-like 'germs' with faces and lots of legs dancing about and making faces at me, 2008. © 2008 mel07green [more]

Thus, Jane10 (subject #23) wrote: "Over the last few weeks I have noticed that the aura status has become 'incorporated' into my dreams. Until recently when I dreamt, any scene I pictured in my dreams would be devoid of the visual disturbances I've described. Now, however, it is often the case that when I dream the images I see are affected by the aura status (I often now dream in grainy vision etc)." Other persistent aura symptoms experienced in her dreams were spots, blurs and trails. Jane10 commented on the huge existential impact of the intrusion of her persistent aura symptoms into her dream life: "I studied various languages in school and university and was always told that you could never become truly fluent in a foreign language until you could dream in that language; I don't want to wax lyrical here, but it's as though the 'language' of aura status has overtaken me." In addition to dreams where he saw his persistent visual snow, Starrant (subject #138) remembered recurrent "dreams where I will be blinded in the dream from a very bright light". In one dream, his view of a woman's face was "distorted with weird visual symptoms, which I am of course used to in real life", reminiscent of his previous attack of migraine aura without headache in January 1998 when he had noticed having "trouble seeing people's faces" for about 20 minutes. In another dream, he experienced a body image disturbance whereby he first "felt upside down and really dizzy" (with inverted vision of his dream environment) and then "like flying away" before he "woke up from that dream" with his "VS worse than ever, like it was worse than it normally can be upon wakening!" Jimjones235 (subject #172) "had a few nightmares about being dizzy..." MisterClean12 (subject #189) recalled a single time when he "had snow in my dream... The snow was very 'heavy' -- much more than I experience in reality... I remember thinking, 'Hey, there is snow in my dream. This is so weird.' ... I recall that it was a vivid dream and I realized I was dreaming only when I noticed the VS. So I would not categorize it as lucid from the beginning..." (A lucid dream is a dream where the dreamer is conscious of being dreaming.) Then, "upon awakening at night, not only was my snow much more intense, but I saw colored wavy lines mostly in my left visual field... I fell back to sleep and the next morning the wavy lines were gone. My snow intensity was at its usual level." Sonne (subject #318) had a dream of visiting an eye doctor who made a hearing test rather than an ophthalmological examination. She couldn't understand anything with this odd test, but looking out of the doctor's office's window she saw the visual snow, flickering and the afterimages. Another night she dreamt "that I have closed the eyes (seeing blackness) and someone treated me osteopathically. In doing so many colourful lights appeared in the blackness. Weird dream…" Having suffered from persistent vertigo and dizziness since the onset of her 8th episode of persistent aura without infarction in March 2006, SopuliSusie (subject #405) experienced the onset of her 13th episode of the aforementioned migraine complication with a significant worsening of the given vestibular symptoms during a lucid dream whilst taking a nap on February 9, 2007. "I had a dream I was spinning around in circles uncontrollably (hovering over my bed, no less) and then I woke up dizzy and stayed dizzy... I do have vertigo and dizziness every day, but the worsening on Sunday was enough that I was falling down and crashing into walls... I'm having to rehabituate to my new rate of vertigo and rely on all those tricks the physical therapists taught me for walking around being super dizzy...." A month later, she had another dream with "a couple of aura features (that I remember). One was of everything becoming tilted. So in my dream, the world tilted and I started sliding off my bed, tumbling on the floor, and falling more. At some point in my dream, I get up, go to another room and try to open my eyes, but everything is blank. Then a point of light in the middle of the field of view starts to open in a scintillating way, and as it opens up further, I see a very vivid Asiatic lily. But, it wasn't real and I knew it wasn't real - it was that part vivid, part fake way that a positive afterimage has. That is very different from my usual grey spot scotomas, and more like the transitory ones I get (big, obvious, colorful, very scintillating). In both this dream, and the other one from before, I was conscious of being asleep and dreaming. And with this one, it was like I was keeping mental notes of what I was seeing because I knew some of it was different. So odd. After I woke up, which took a while, I was dizzy and had vertigo, and had a general worsening of my visual symptoms."

SopuliSusie [subject #405], Odd dream scotoma thing, 2008. © 2008 SopuliSusie (larger image see here)

In all aforementioned 6 subjects (#23, #138, #172, #189, #318, #405), the dreams incorporating persistent and/or transitory other aura phenomena culminated in awakening from sleep, in one case (subject #189) following an intermediate stage where the dream had become lucid, both of which phenomena can be interpreted as sequelae from the arousal (Schönhammer, 2005) produced by the ongoing activity of migraine with aura. It is worth noting that 3 of the 6 subjects not only perceived their usual persistent aura symptoms in the previously quoted dreams, but either an increased intensity of these persistent symptoms (subject #189, #405) or transitory other aura phenomena (subjects #138, #405), suggesting attacks of nocturnal migraine with aura.

jruddy [subject #515], Visual snow in a lucid dream/nightmare, 2008. © 2008 jruddy

All of these 3 subjects (#138, #189, #405) mentioned a short-lasting worsening of the intensity of visual snow immediately after awakening from the previously mentioned deams, which can be explained by the effect of the supposed ongoing attack of migraine with aura, corresponding to the well documented effect that an attack of migraine with aura sustained by a persistent aura sufferer in the awake state of consciousness can transitorily worsen the intensity of persistent aura symptoms (item B.10 of MAS score). One subject (#405) reported a persistent (duration > 7 days) significant worsening of her persistent aura symptoms of dizziness and vertigo, corresponding to another episode of persistent aura without infarction.

Against the background of these clinical observations, it is suggested that the transitory worsening of the intensity of persistent aura symptoms after awakening, which has been reported by 12 subjects (#23, #42, #138, #147, #159, #162, #189, #230, #382, #405, #515, #555) without any recall of immediately preceding dreams, can be attributed to the same effect of an ongoing attack of nocturnal migraine (Dexter and Riley, 1975) which awakens the subject by the arousal produced by it (see here).

Similar "vs dreams" and related dream phenomena are reported by 9 subjects (#51, #161, #173, #272, #282, #346, #503, #505, #510) with possible persistent aura without infarction; their data will not be analysed in further detail here. One subject (#507) related that he never experienced persistent aura symptoms during lucid dreams, sleep paralysis or out-of-body-states. As a lucid dreamer, he described being aware of the transition between the VS experience and the VS-free dream vision. "First of all, I can tell you that when I'm dreaming there are no visual snow or other weird things that disturbs my vision... if I enter a dream from awaken state, the VS dissapears very rapidly the last seconds before the inner vision (dream vision) takes over... In other forms of consciousness than normal, like sleep paralysis, out-of-body-experiences, there is no visual snow neither."

References

Dexter JD, Riley TL. Studies in nocturnal migraine. Headache 1975; 15: 51-62.
Mulder T, Hochstenbach J, Dijkstra PU, Geertzen JH. Born to adapt, but not in your dreams. Conscious Cogn 2007 May 10. [Epub ahead of print]
Schönhammer R. 'Typical' dreams. Reflections of arousal. Journal of Consciousness Studies 2005; 12 (4-5): 18-37.

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