All of them experienced either depression or euphoria during their attacks. Six of the seven had an actual or previous affective disorder. Morrison found that seven of 46 female patients who were referred due to migraine experienced abnormal perceptions (smell and/or taste hallucinations and distorted body image). It is well known that bipolar disorders and migraine are associated. Can we be sure that the patient reported genuine synesthesia and not an acquired memory association? In fact, taste as the concurrent perception of vision in synesthesia is considered rare, and that colors may have a profound effect on the perceptions of odors (and taste) is well-known, and the association between yellow and lemon seems to be robust. Similar to several other reports of patients with synesthesia, the present patient had a creative job. Neurological examination, cerebral MRI, standard and sleep-deprived EEG were all normal.
She had no other types of synesthesias, and experienced no other illusions, hallucinations or psychotic symptoms. The aura was sometimes also associated with a short-lasting moody or euphoric feeling.
This was also short lasting but could occur several times throughout the aura, and as she stated: "the flickering is present all along and seems to come from within", but "the other is caused by external stimuli and may be avoided". More conspicuous was an intense taste of lemon with flow from the salivary glands when she stared at strong bright light, especially light rods in the ceiling. She was unable to tell how long the scotoma could last and nor could she give account for the temporal relationship to the scintillations. However, during it she could experience a short lasting grayish central scotoma triggered by loud and high pitch sounds, such as the cry of children. There was no classical spread of the visual disturbance and it never left a scotoma. A flickering with some sparkling was noticed at the rim of the upper lateral visual field(s). On several occasions she had experienced what she called "mixing of senses". This was almost always followed by migraine headache within one hour. She experienced what she characterized as "surrealistic phenomena" never lasting less than two and never more than 30 minutes. The patient was eloquent and described typical migraine, but the aura was curious. She now used petidine (100 mg) against the migraine headache. According to the patient, this halved the migraine attack frequency, and by the time of her consultation she experienced one attack per week in average. Mood-stabilizing treatment with valproate 500 mg/d was initiated. Later the same year she received her psychiatric diagnosis. A genetic test showed that she was a poor metabolizer (CYP2D6, 2549A > del). She had been given increasing doses of a combination of codeine and paracetamol, but no pain relief was achieved. Two years prior to the neurological consultation, the patient's psychiatric problems had piled up, and by that time she suffered two migraine attacks per week. The efficacy of prophylaxis with propranolol was also questionable. Attack treatment with naproxen, rizatriptan and zolmitriptan had been unsuccessful. Her mother suffered from typical visual aura without headache. Here we present a unique case with synesthesias exclusively during visual migraine auras.Ī 40-year-old graphic designer with a bipolar disorder type II had suffered from regular attacks of migraine with and without visual aura over the last six years. Positron emission tomography studies and functional magnetic resonance studies performed on patients who report seeing colors when exposed to auditory stimuli have shown activation in several visual-associated cortical areas. The neurophysiological mechanisms underlying synesthesias are largely unknown, but there are two main theories: cross-activation of the relevant perceptual areas due to a) cross-wirings that were not disconnected after birth or b) anomalous processing in perceptual association areas. It was described in Nature in 1880, and more than a hundred years later, experimental studies validate it as a genuine perceptual experience, and not merely a metaphoric description or a memory association. Synesthesia, the phenomenon of impulses affecting one sense modality, giving a sensation that is normally experienced by stimulation of another sense modality, affects at least one per 100.
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