Reversible palinopsia and the Alice in Wonderland syndrome associated with topiramate use in migraineurs

Headache. 2006 May;46(5):815-8. doi: 10.1111/j.1526-4610.2006.00458_1.x.


Two patients are reported who developed palinopsia while taking topiramate for migraine prevention which resolved or decreased in frequency or duration on lower doses, but recurred or increased in frequency or duration on higher doses. Both patients had complete resolution of palinopsia when topiramate was discontinued. A third patient is described who developed the "Alice in Wonderland" syndrome about 1 week after starting topiramate for migraine prevention with complete resolution of symptoms about 1 month after stopping. Topiramate use may cause palinopsia and may be associated with the Alice in Wonderland syndrome through an unknown mechanism.

MeSH terms

  • Adult
  • Afterimage / drug effects*
  • Afterimage / physiology
  • Anticonvulsants / adverse effects*
  • Body Image
  • Female
  • Fructose / adverse effects
  • Fructose / analogs & derivatives*
  • Humans
  • Middle Aged
  • Migraine Disorders / drug therapy*
  • Migraine Disorders / physiopathology
  • Migraine Disorders / prevention & control
  • Perceptual Distortion / drug effects*
  • Perceptual Distortion / physiology
  • Topiramate


  • Anticonvulsants
  • Topiramate
  • Fructose