Hearing voices: does it give your patient a headache? A case of auditory hallucinations as acoustic aura in migraine

Abstract

ObjectiveAuditory hallucinations are generally considered to be a psychotic symptom. However, they do occur without other psychotic symptoms in a substantive number of cases in the general population and can cause a lot of individual distress because of the supposed association with schizophrenia. We describe a case of nonpsychotic auditory hallucinations occurring in the context of migraine.MethodCase report and literature review.ResultsA 40-year-old man presented with imperative auditory hallucinations that caused depressive and anxiety symptoms. He reported migraine with visual aura as well which started at the same time as the auditory hallucinations. The auditory hallucinations occurred in the context of nocturnal migraine attacks, preceding them as aura. No psychotic disorder was present. After treatment of the migraine with propranolol 40 mg twice daily, explanation of the etiology of the hallucinations, and mirtazapine 45 mg daily, the migraine subsided and no further hallucinations occurred. The patient recovered.DiscussionVisual auras have been described in migraine and occur quite often. Auditory hallucinations as aura in migraine have been described in children without psychosis, but this is the first case describing auditory hallucinations without psychosis as aura in migraine in an adult. For description of this kind of hallucination, DSM-IV lacks an appropriate category.ConclusionPsychiatrists should consider migraine with acoustic aura as a possible etiological factor in patients without further psychotic symptoms presenting with auditory hallucinations, and they should ask for headache symptoms when they take the history. Prognosis may be favorable if the migraine is properly treated. Research is needed to explore the pathophysiological mechanism of auditory hallucinations as aura in migraine.

Auditory hallucinations associated with migraine: Case series and literature review

“…Of 4238 patients seen at our center during the eightyear time period, seven reported auditory phenomena related to headache, a prevalence of 0.17%. Literature review yielded an additional nine patients experiencing auditory hallucinations in conjunction with headache disorders (19)(20)(21)(22)(23)(24). Unlike our clinic cases, most of the case reports lacked detail of headache presentation or patients' medical and psychiatric comorbidities.…”

“…Auditory hallucinations are often associated with psychosis but may also manifest in the presence of both affective disorder and anxiety (34). Since more than half of our sample reported a history of depression and anxiety disorders, its presence could be related to psychiatric comorbidity, which ideally would be clarified by longitudinal study (19,35).…”

Extended network analysis: from psychopathology to chronic illness

“…In addition, interestingly, the psychosis item was the only psychopathological item that fell in between the two domains of the network, being connected to psychopathology, but also to the chronic conditions through its association with migraine headaches. Side-effects of antipsychotic medication can include headaches [ 41 , 42 ], but some evidence suggests severe forms of migraine–such as migraine aura–can also be associated with psychotic manifestation [ 43 – 45 ]. Psychosis and obsessions were also interrelated, indicating this association may already present at subclinical levels of psychopathology, and not only in patients [ 46 ], or in subjects at ultra-high risk for psychosis [ 47 ].…”

Aura-like features and photophobia in sightless migraine patients

“…Auditory aura is rarely observed in migraine, but auditory hallucination has been reported as a type of acoustic aura 25 . Our case and the one described by Kowacs et al 6 in a small sightless population contrast the rarity of this phenomenon in ordinary migraine, indicating that acoustic aura may be significantly more common among blind subjects.…”