The Alice in Wonderland Syndrome and Migraines

Alice in Wonderland Syndrome
Those who suffer from chronic migraine episodes are all too familiar with the symptoms and side effects. But physicians are hearing more and more about a particular side effect that patients may not be talking about as much as they should. Known as The Alice in Wonderland Syndrome (AIWS), this condition is a neurological phenomenon that is characterized by distorted perceptions, disorientation and warped senses. It seems to be more common in children, but also present in adults with frequent migraines. 

To begin with, it’s important to understand that a migraine episode can have as many as four phases of development: prodrome, aura, migraine attack, and postdrome. Not everyone will experience every phase of the migraine lifecycle, but everyone experiences at least bits and pieces. 

The Aura phase

Migraine auras are disturbances that are usually visual, but can also be sensory, motor or verbal and occur minutes or hours before migraine pain sets in. Fifteen to 20% of migraine sufferers describe experiencing:

  • Blurred vision

  • Appearance of floaters (tiny specks that float before the eyes)

  • Flashes of light or color

  • Blind spots or total blindness in one eye

It is in this phase that some patients describe symptoms of the Alice in Wonderland syndrome. 

The Alice in Wonderland Syndrome 

Also known as Todd’s syndrome, this condition was first recognized in 1955 by psychiatrist, John Todd after several of his patients described encounters with strange visual and auditory disturbances. Todd noted that there were no signs of mental illness, brain tumor, epilepsy or any other condition that might cause such symptoms and each patient had a family history of migraines. 

Symptoms of AIWS are usually described as: 

  • Hallucinations

  • Lost sense of time

  • Incorrectly perceived body part sizes and shapes

  • Incorrectly perceived external objects 

  • Distorted touch perception

  • Imprecise sound sensitivity 

Todd named the syndrome after Lewis Carroll’s ‘Alice in Wonderland’ because of the similar nature between his patient’s symptoms and the phenomenon experienced by the main character in Carroll’s story. Individuals describe their body parts growing or shrinking, external objects changing size or shape, time seeming to pass very fast or stand still, odd touch sensations (like the feeling of sponginess against a hard surface) and even distorted auditory function, like voices sounding far away when they are actually near by. 

The syndrome has not yet been widely recognized by healthcare professionals and the causes are still undetermined.  However, AIWS appears to precede a migraine episode much in the same ways as auras.

Treatment of The Alice in Wonderland Syndrome

Because so little is known about the cause of AIWS, an exact treatment method is unknown. There are a couple theories as to why this syndrome has such little recognition. 

  1. Children who experience AIWS are too young to describe what they are experiencing or they are simply unafraid and so, aren’t bothered by it enough to tell an adult.  

  2. Adults who experience AIWS are fearful of being labeled as ‘crazy’ so they do not seek help or talk about their condition unless it affects other areas of their lives. 

 If diagnosed, treatment is similar to that of the first line of defense for migraine management. 

  • Anti depressant prescription

  • Anti convulsion prescription

  • Nerve block injections

  • Dietary and lifestyle alterations

This approach has proven to reduce AIWS symptoms and can help to curb episode frequency. 

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