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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.

Stephen D. Silberstein

Pikes, Stars, and Shimmering Lines

To some sufferers, the fortification lines appear to march in military fashion; in his diaries, Carroll records an “odd optical affection of seeing moving fortifications.” He also alludes to difficulties with the vision in his right eye, followed in at least one instance by a headache. Carroll does not seem to have gone public with his migrainous experiences, and perhaps he never even consulted a physician about them. Neverthless, he managed to transplant them into the minds of millions of readers, and he continues to pull off this feat long after his death.

Diagnostic terminology has followed the lead of Carroll’s art. A paper recently published in Neurology tells the story of how the term “Alice in Wonderland syndrome” came into use in the 1950s for the paroxysmal body image illusions that can constitute one kind of migraine aura.

Regardless of the medium in which they are created, art and literature have long served as valuable sources for investigating the neural activity that produces a migraine aura. As the cortical spreading depression propagates across the cortex, the scotoma or fortification pattern appears to move. The protagonist in de Chirico’s autobiographical novel, Hebdomeros, suffers a migraine attack in which he sees strange shapes that “all went away in a corkscrew formation, or else in regular zigzags, or else in strictly perpendicular fashion resembling pikes carried by a disciplined troop.”

2014-05ArtsLabFp228bot.jpgClick to Enlarge ImageAmong the earliest migraine sufferers to record her experience in pictures as well as text was Hildegard von Bingen, a 12th-century German abbess, philosopher, and composer. Like so many migraine sufferers, she was bewildered and frightened at first by the unearthly sights of her migraine aura. Their source was clear to her, however. As someone who from the age of eight spent her life in religious orders, Hildegard naturally saw these visions as glimpses of the divine.

Of one episode, she writes: “I saw a great star, most splendid and beautiful, and with it an exceeding multitude of falling sparks with which the star followed southward . . . and suddenly they were all annihilated, being turned into black coals . . . and cast into the abyss so that I could see them no more.” The jagged edges of a star, flashes of light from moving sparks, and the subsequent blackness—to recognize all these perceptions as typical of a migraine aura does not contradict the profoundly spiritual nature of this sufferer’s migraine experiences. Although she did not receive a formal education, Hildegard kept up with the best scientific thinking of her time; she read widely, developed a theory of cosmology, and was known as a gifted herbalist. Simply, the visions of migraine aura carried a religious meaning for her because that was the form her mind imposed on them.

2014-05ArtsLabFp228top.jpgClick to Enlarge ImageIn similar fashion, Carroll’s incongruously cheerful sketch illustrates the quirky mind of the creator of Alice in Wonderland, and de Chirico’s painting conveys the surrealist milieu in which he lived and worked. Friedriech Jolly, a German neuroloist and psychiatrist who was himself a migraine sufferer, combined personal experience and a clinical turn of mind in illustrating the flickering zigzags of migraine aura, which he believed to be “a malady that affected primarily the Learned Classes,” on account of their extensive reading.

Bringing the story of migraine aura illustration up to date are the ever-changing collections that now proliferate on the Internet, as well as in artistic competitions large and small. The example below at right, by painter and writer Petrie Serrano, shows wavy, sinuous lines in place of the time-honored zigzags, but at the same time it re-creates other effects that are unhappily familiar to many migraine sufferers: a sense of movement and of disorientation.

2014-05ArtsLabFp229.jpgClick to Enlarge ImageWith an incidence calculated by the World Health Organization to be about 3,000 migraine attacks per million people per day, it is hardly surprising that artistic depictions of migraine aura should look so varied even as they contain many of the same basic elements. What is surprising—what is perhaps even wonderful—is that the artistic mind can manage again and again to infuse a chaotic, painful experience with meaning and occasionally, somehow, with beauty.


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