One of the aspects of being both autistic and a migraineur, is that I am often unaware of an impending migraine until it reaches the acute phase – a throbbing headache. Before I go any further I need to point out to any reader who thinks a migraine is simply a very bad headache, it isn’t. There is a spectrum of symptoms related to migraines, and a throbbing headache, while the most common and perhaps most well known symptom, is but just one of many. Each migraineur will have a different list of symptoms that affect them, and any single migraine attack can contain any combination of those symptoms.
I’m perhaps fortunate in that most of my migraines don’t develop full blown migrainous throbbing headaches – what is known as the acute or headache phase of a migraine attack. Migraines are often described as having four phases: the prodrome which can last from several hours to several days; the aura phase, which are typically 10 – 30 minutes but can last for several hours and very rarely in some individuals for more than a day; the acute or headache phase which can last for hours and occasionally days; and finally the postdrome, which can last from hours to days.
I’ve been flipping into and out of aura phases for several days without having anything other than the occasional mild headache. I don’t think my cognition has been affected for which I’m grateful, as losing cognitive skills is perhaps the most debilitating, not to mention dangerous, aspects of migraine attacks for me.
At this moment I am most definitely in an aura phase and as far as I can tell, it’s only affecting my vision, so I thought this might be an opportunity for me to attempt to describe what I’m experiencing while I’m lucid. So let’s begin.
I’m sure most people have seen the shimmering effect of a heat haze, if not here are two examples:
However, unlike a real haze, the distortion created by my migraines is not affected by distance. Everything shimmers regardless of how near or how far away it is. Another way of describing the distortion might be looking at objects below water from above the water. As the surface ripples, the objects below seem to move or shimmer.
Another visual distortion that occurs during my migraine is double vision. Here’s a simulation:
Here’s another illusion caused by migraine. If you’ve ever driven in the rain without switching on the windscreen wipers, or if you’re out in the rain while wearing glasses you’ll experience something similar:
Currently I’m experiencing all three effects simulated above at the very same time. But wait, I’m not finished yet. There’s one illusion I haven’t sound a satisfactory simulation of. That is a type of blind spot that isn’t. Let me explain this way:
What we see is not an exact recreation of the image that arrives on the retina. That image is processed to clean up extraneous artifacts in much the same way as analogue and digital photographs can be enhanced to remove such things as a hair or dust on the lense or to remove that annoying overhead power line that is spoiling an otherwise perfect shot. The human eye has several “flaws” that affect the image we perceive – blood vessels, floaters within the eye, and a blind spot on each retina for example. We usually don’t notice these artifacts as the brain is quite capable of cleaning up the image and “filling in the blanks”, and we aren’t even aware of it happening.
I’m not a neurologist, so the following explanation is only an approximation of what I think happens but it does describe my experience. Many migraineurs experience blind spots. These aren’t spots that appear light or dark, or as a colour, but as nothingness. It’s very difficult to describe, and I suspect one needs to have experienced it to understand it. I do experience these, but sometimes my brain seems to into overdrive and attempt to fill in the missing information.
Perhaps the best example and one that occurs frequently is what I have termed the “missing clock on the wall” syndrome. This is most readily reproducible when the wall has a regular background pattern such as a wallpaper. If I attempt to look at the clock and it is obscured by a blind spot, instead of seeing nothing, I can see the wallpaper pattern as if the clock wasn’t even there. Somehow my brain has calculated what part of the wallpaper pattern is missing and recreates it.
I’ve even had the situation where the blind spot covers an area slightly smaller than the clock but as large as the clock face. This results in the clock frame being visible, but there is a hole where the the face should be and I can “see” the wallpaper behind it. It can be quite surreal.
The above are merely some of the visual auras that migraineurs experience – I also loose the ability to perceive distance, but I don’t know whether that is due to the distortions I’ve described above or whether it’s due to another part of the brain malfunctioning.
Then there are other forms of aura that are not visual that many migraineurs experience. Here’s one that isn’t a simulation:
No, Serene Branson was not having a stroke, nor had she taken any drugs. She was experiencing a migraine aura that affected her ability to form words. I’ve experienced this often, although perhaps not quite as extreme as the one that Serene experienced above. However there are times when I’m unintelligible and my enunciation drops off. I sometimes sound as though I’ve had a few too many drinks.
Then there’s occasions where motor skills are affected. Balance can become difficult, and tasks such as tying shoelaces or pouring water into a cup become extreme feats of concentration with no guarantee of success. Even doing up buttons can become nigh on impossible, and as for going to the toilet, well let’s just say standing during the performance is very unwise.
And then there’s photophobia, where bright lights, strong contrasts and rapid movement within my field of vision can be painful. Most people have experienced the feeling when a very bright light is unexpectedly shone in their eyes. Just multiply that discomfort by an order of magnitude.
Another aura I experience is phonophobia. If you’ve ever suffered from a severe hangover, you’ll know exactly how painful loud or sudden noises can be. Other auras I experience is hearing sounds that don’t exist. I often faintly hear a telephone ringing or the wife calling my name from a distance, but neither are real. And finally, well, for this post, the senses of taste and smell are affected. Not only do some smells that I usually like become disgusting – especially sweet smells, but I often think I can smell slightly overdone toast, almost, but not quite burnt. Then there’s the metallic taste that lingers in the mouth, but to be honest that’s the least my concerns as nausea and vertigo seem to quash any desire for food.
It’s now around eight hours since I completed the first draught of this article, and I’ve just spent some time tidying up the text, mostly adding words I thought I had included but hadn’t, and placing words into the order that most English speakers expect. If I hadn’t done that, readers would have found a few sentences that, in written form, were about as intelligible as Serene Branson’s spoken sentences in the clip above.
I’ve avoided using the term hallucination to describe some of what I experience, as these are not a product of the mind. Instead they are a product of the processing of the senses, so the term illusion would be a more appropriate fit.