Alice in Wonderland Syndrome and Visual Migraines

alice in wonderland engravingSometimes the world doesn’t look right when you have a migraine. Colors change. Straight lines turn wavy. Objects move. Time may even seem to shift.

In 1955, British psychiatrist John Todd named this strange condition Alice in Wonderland syndrome (AIWS) after the storybook character.

During her adventures, the way Alice sees the world shifts again and again after she falls down a rabbit hole. At one point, she sips from a bottle marked "drink me" and shrinks small enough to fit through a tiny door. Then she eats a cake marked "eat me" and grows large enough to reach a key on a tall table.

Todd used the term to describe the odd symptoms he'd heard about from people he treated for migraine headaches and epilepsy.

Symptoms

Strange things happen when you have an episode of AIWS:

  • Your body parts or things around you may look bigger, smaller, closer, or farther away than they really are.
  • Straight lines may look wavy.
  • Things that are still may seem to move.
  • Three-dimensional objects may look flat.
  • Things may change colors or tilt to the side.
  • Faces may look distorted.
  • Colors may look extra bright.
  • People and objects may look stretched out.

Causes

Doctors aren't sure why some people have these unusual changes in perception. But it often starts when children are very young.

AIWS involves changes to parts of your brain that deal with sensory information -- what you see and hear. These changes affect how you see your own body and its relation to the world around you.

Doctors believe AIWS might be a type of migraine aura. Auras are visual and other sensory problems some people get before or during a headache. They can cause things like flashing lights, shimmering spots, ringing in your ears, or a tingling in your hands.

AIWS often happens before, during, or after a migraine. But it also can happen with these other conditions:

It also can happen after taking medication like cough syrup, allergy medicines, and the anti-seizure drug topiramate (Topamax).

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Diagnosis

If you think you may have AIWS, you may want to see a neurologist. That's a specialist who treats problems with your brain, spinal cord, and nerves. They'll ask about your symptoms and your history of migraines.

They also may suggest some of these tests:

  • Blood tests. Medical staff will take a sample of your blood from a vein, usually in your arm, to find out if you have the Epstein-Barr virus or another virus that causes AIWS.
  • Magnetic resonance imaging (MRI). This scan uses powerful magnets and radio waves to make detailed images of your brain.
  • Electroencephalogram (EEG). This measures the electrical activity inside your brain.

Treatments

There's no treatment for AIWS, but you may be able to avoid the strange sensations by staying away from things that trigger your migraines. You can try medicines like:

  • Antidepressants
  • Anti-seizure drugs
  • Blood pressure medicines, such as calcium channel blockers and beta-blockers

Your doctor also might suggest that you switch to a diet designed to help you have fewer migraines. Tips include:

  • Eat foods like fruits, vegetables, eggs, fish, meat, and poultry.
  • Instead of three big meals, eat five to six smaller meals throughout the day. Hunger can cause headaches in some people.
  • Stay away from foods that set off your headaches. Common migraine triggers include alcohol, the sweetener aspartame, soft or aged cheeses, monosodium glutamate (MSG), and processed meats like hot dogs and bacon.
WebMD Medical Reference Reviewed by William Blahd, MD on March 16, 2017

Sources

SOURCES:

American Migraine Foundation: "Controversies in Headache Medicine: Migraine Prevention Diets."

BioMed Research International: "Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review."

Journal of Pediatric Neuroscience: "Alice in Wonderland syndrome: A rare neurological manifestation with microscopy in a 6-year-old child."

Mayo Clinic: "Migraine: Treatment," "Migraine with aura: Overview," "Migraine with aura: Symptoms and causes."

Neurology Clinical Practice: "Alice in Wonderland Syndrome."

Pediatric Neurology: "'Alice in Wonderland' syndrome: presenting and follow-up characteristics."

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