Migraines affect about 39 million people in the United States, including children. A 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 include throbbing pain that is sometimes accompanied by throbbing symptoms, including:
- numbness or tingling
- vision changes
- weakness
- trouble speaking
Some people also report different types of aura. However, hallucinations are different, and they are rare in people with migraine.
Visuals usually don’t involve seeing things that your brain makes up. More commonly, they are visual disturbances caused by overexcitability of their occipital cortex.
Can Migraine Cause Visual Hallucinations?
Some people who have migraines have sensory disturbances, but they likely aren’t hallucinating. Hallucinations are sensory experiences that may seem real but are actually created by your mind.
Visual hallucinations are relatively common and can include various sensory disturbances such as visual patterns or lights. Knowing what can trigger a migraine attack can help you recognize what’s going on.
Visual auras are the most common types of aura. Symptoms of visual acuity may include:
- jagged flashes of light or bright spots
- some vision loss or blind spots
- zigzag lines or geometric shapes in your vision
Although simple visual hallucinations are commonly seen with migraine, complex visual hallucinations, such as those in fully formed people or animals, may occur with basilar migraine or familial hemiplegic migraine.
Complex visual hallucinations with hemiplegic migraine usually appear in the late phase of a migraine attack and may last for 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. It can occur as a flare in migraine.
Can Migraine Cause Auditory Hallucinations?
Auditory hallucinations associated with migraine are uncommon and are not recognized as a symptom by the International Headache Society.
In a study that looked at auditory hallucinations and migraines, the most common symptom was hearing voices. They last about an hour and usually occur during the headache phase.
About half of people with migraines and auditory hallucinations also had a psychiatric disorder — usually depression. This may suggest that auditory hallucinations are not necessarily a form of aura, but something else.
Can Migraine Cause Olfactory Hallucinations?
Sensitivity to smell is common in people living with migraines, which affect about 95 percent of people with the disease.
During a migraine attack, olfactory hallucinations may also occur. These are much rarer, and during these hallucinations the person smells specific things that those around them do not. Bad breath is also associated with headaches. Bad breath usually occurs before or during a migraine attack.
Olfactory hallucinations with migraine occur in about 0.1 percent of adults with migraine.
In one study, most people with migraines had fewer than 15 headaches per month without migraines. All of them had light and sound sensitivity with their migraine attacks. This was a small study, and more research is needed.
Although specific odors may vary among people, odors can be either unpleasant or pleasant. There is no specific type of olfactory hallucination associated with migraine.
When to Get Medical Help
Make an appointment with a doctor if you are feeling delusional about your migraine attacks. They will talk with you about your symptoms, perform a physical exam, and order tests to rule out any other possible causes of hallucinations.
They may order blood or urine tests, as well as imaging tests such as a brain MRI.
They will be able to determine whether the hallucinations are part of the hallucinations or a sign of another medical problem. Once the underlying cause of the hallucinations is known, appropriate treatment can be given.
If hallucinations are determined to be a part of the vision, your doctor will consider the best ways to help treat the symptoms of hallucinations and ways to reduce them. This may include:
- putting a cold compress on your forehead or the back of your neck
- taking medication, for both prevention and treatment
- going into a dark, quiet room to lie down and close your eyes
Prevention medications that may be used if the hallucinations are part of the aura include:
- antidepressants like amitriptyline
- calcitonin gene-related peptide (CGRP) antagonists
- blood pressure medications like beta-blockers
- anti-seizure drugs like topiramate
- botulinum toxin (Botox)
Medicines to treat migraines and flashes can help reduce the severity of symptoms once they appear. The sooner you take the medicine, the more effective it will be. These medications may include:
- Over-the-counter pain relievers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
- Gepants and ditons, two new treatments that target receptors and sensory nerves.
- Triptans such as rizatriptan or sumatriptan
- dihydroergotamine
- Anti-nausea medication
Summary
Sometimes hallucinations can accompany migraines, often with flashes. These hallucinations can be visual, auditory, or olfactory.
If you have any hallucinations with a migraine or even after the migraine has resolved, tell your doctor. They can perform an exam and order any necessary tests to help you determine the underlying cause and get the proper treatment.
If the hallucinations are related to aura, treatments are available to manage them. You and your doctor can work together to find the most effective treatment for your symptoms.
