Migraine and Cluster Headache

Migraine aura is well recognized as a cause of simple visual hallucinations; complex dream-like visual hallucinations are less common. They are seen more frequently in migraine coma and in familial hemiplegic migraine. Rarely migraine-associated hallucinations may be of purely auditory nature, possibly reflecting a dysfunction of the temporal lobe due to ischemia [142, 143]. Olfactory, gustatory and other more complex hallucinations such as temporal-visual distortions have all been reported [144, 145]. Podoll and Robinson described the unusual case of auditory-visual synesthesia during migraine attacks: the visual hallucinations consisted in a colored geometric figure induced by the sound of the alarm clock, which then disappeared with the alarm [146]. A few cases of recurrent lilliputian hallucinations during migraine attacks have been reported, although this type of hallucinations is usually associated with mesen-cephalic and/or thalamic lesions (peduncular hallucinosis) [147].

Levitan et al. analyzed the content of 23 dreams that immediately preceded a migraine attack, finding a significant predominance of powerful negative emotions [148].

Recurrent dreams and nightmares have been reported as aura equivalent [149].

A few patients with cluster headache may report a visual aura, often characterized by black-and-white flashing lights preceding the attacks. One patient with cluster headache has been described to have olfactory hallucinations ("bad citrus fruits smell") preceding the attack by 3-4 minutes [150].

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