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Published on: June 2, 2014
Auditory hallucinations associated with migraine: Case series and literature review
Eli E Miller1, Brian M Grosberg2, Sara C Crystal3
1Albert Einstein College of Medicine, USA.
Objective:
The objective of this review is to describe auditory hallucinations (paracusias) associated with migraine attacks to yield insights into their clinical significance and pathogenesis.
Background:
Isolated observations have documented rare associations of migraine with auditory hallucinations. Unlike visual, somatosensory, language, motor, and brainstem symptoms, paracusias with acute headache attacks are not a recognized aura symptom by the International Headache Society, and no systematic review has addressed this association.
Methods:
We retrospectively studied patients experiencing paracusias associated with migraine at our center and in the literature.
Results:
We encountered 12 patients (our center = 5, literature = 7), 58% were female, and 75% had typical migraine aura. Hallucinations most commonly featured voices (58%), 75% experienced them during headache, and the duration was most often <1 hour (67%). No patients described visual aura evolving to paracusias. Most patients (50%) had either a current or previous psychiatric disorder, most commonly depression (67%). The course of headache and paracusias were universally congruent, including improvement with headache prophylaxis (58%).
Conclusion:
Paracusias uncommonly co-occur with migraine and usually feature human voices. Their timing and high prevalence in patients with depression may suggest that paracusias are not necessarily a form of migraine aura, though could be a migraine trait symptom. Alternative mechanisms include perfusion changes in primary auditory cortex, serotonin-related ictal perceptual changes, or a release phenomenon in the setting of phonophobia with avoidance of a noisy environment.
Insights
Auditory hallucinations (paracusias) rarely occur with migraine, often featuring voices during headache. These symptoms, common in depression, may indicate a migraine trait rather than aura.
Area of Science:
- Neurology
- Ophthalmology
- Psychiatry
Background:
- Auditory hallucinations (paracusias) are rarely documented with migraine.
- Unlike other aura symptoms, paracusias are not recognized by the International Headache Society.
- No systematic review has previously addressed the association between migraine and paracusias.
Purpose of the Study:
- To describe auditory hallucinations (paracusias) associated with migraine attacks.
- To gain insights into the clinical significance and pathogenesis of paracusias in migraine.
- To systematically review the literature on paracusias and migraine.
Main Methods:
- Retrospective study of patients experiencing paracusias with migraine.
- Analysis of cases from the authors' center and existing literature.
- Review of clinical characteristics, timing, duration, and co-occurring conditions.
Main Results:
- 12 patients identified (5 from center, 7 from literature); 58% female.
- Hallucinations most commonly featured voices (58%), occurring during headache (75%) for <1 hour (67%).
- 50% had a psychiatric disorder (67% depression); symptoms were congruent with headache and improved with prophylaxis.
Conclusions:
- Paracusias uncommonly co-occur with migraine, typically involving voices.
- The timing and prevalence in depression suggest paracusias may be a migraine trait, not aura.
- Potential mechanisms include auditory cortex changes, serotonin effects, or phonophobia-related phenomena.
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