A Perspective on the Migraine Mind
Visual depictions of auras offer an inside peek into the sensory chaos that lies behind a migraine’s debilitating pain.
Jagged Edges and Blank Spots
Describing a subjective visual experience is difficult for most migraine patients, and challenging for researchers to describe accurately in the scientific literature as well. Fortunately, artists have found a great many ways to record the influence of migraine aura in their works, and these depictions have proved useful for characterizing specific effects of the cortical spreading depression on the intricate circuitry in the brain that allows us to see.
Take the sketch on the opening page of this article, for example. Lewis Carroll, who was known to suffer from terrible headaches, drew this frontispiece sometime around 1855 for a magazine called Mischmasch that the Carroll family produced from time to time. Playful and amusing at first glance, the sketch also has an alarming side—specifically, the right side, where the figure is missing a hand, a shoulder, and a portion of his head. These areas are not indicated in a tentative way, nor are they obscured. They are simply blank, as if to say, ”Nothing to see here.” And in fact, Carroll may have seen nothing there, even though he surely was aware that there should have been more to see.
Psychiatrist Klaus Podoll and his coauthor Derek Robinson, in their book Migraine Art: The Migraine Experience from Within, point out that the blank area in the sketch offers a clinically accurate depiction of the migraine symptom known as a scotoma—a blind spot or defect in the field of sight, one of many tricks that migraine aura can play on the visual system.
The negative scotoma in Carroll’s drawing has as its counterpart the positive scotoma, as seen on this page in a 1969 painting by Giorgio de Chirico called The Return to the Castle. (The poet Guillaume Apollinaire, a friend of the painter and a fellow surrealist, has suggested that de Chirico often worked under the influence of migraine.) Here the blind spot appears, to dramatic effect, in the shape of two figures that are clearly identifiable, down to the detail of the horse’s reins and the plume on the knight’s helmet. At the same time, the dark shape blocks the view of a large part of the serene landscape. In opposite ways, Carroll’s drawing and de Chirico’s painting both call attention to what cannot be seen in the midst of a migraine aura; the viewer, willingly or not, shares in their experience.
Migraine-inspired art emerged in the 1970s as a distinct subgenre with the launching of a foundation for its display and for its wider recognition (www.migraine-aura.com). National and then international art competitions soon followed; by 2006, an Internet survey of such contests by Podoll found entries from 450 artists representing 25 countries. Podoll concludes, “Far from being being just relevant as an art-inspiring factor in the context of Migraine Art contests, migraine experiences can be shown to act as a source of inspiration in a considerable number of contemporary artists.”
The most common feature of a migraine aura—some clinicians call it “almost diagnostic” of the migraine experience itself—is the appearance of parallel zigzag forms across one’s field of sight. These lines are termed fortification patterns, for their resemblance to the walls built around medieval towns to defend them from invasion. (The more impressive term “teichopsia,” from the Greek for “town-wall vision,” comes to much the same thing.)