Auditory hallucinations associated with migraine: Case series and literature review

Cephalalgia. 2015 Sep;35(10):923-30. doi: 10.1177/0333102414563088. Epub 2014 Dec 5.


Objective: The objective of this review is to describe auditory hallucinations (paracusias) associated with migraine attacks to yield insights into their clinical significance and pathogenesis.

Background: Isolated observations have documented rare associations of migraine with auditory hallucinations. Unlike visual, somatosensory, language, motor, and brainstem symptoms, paracusias with acute headache attacks are not a recognized aura symptom by the International Headache Society, and no systematic review has addressed this association.

Methods: We retrospectively studied patients experiencing paracusias associated with migraine at our center and in the literature.

Results: We encountered 12 patients (our center = 5, literature = 7), 58% were female, and 75% had typical migraine aura. Hallucinations most commonly featured voices (58%), 75% experienced them during headache, and the duration was most often <1 hour (67%). No patients described visual aura evolving to paracusias. Most patients (50%) had either a current or previous psychiatric disorder, most commonly depression (67%). The course of headache and paracusias were universally congruent, including improvement with headache prophylaxis (58%).

Conclusion: Paracusias uncommonly co-occur with migraine and usually feature human voices. Their timing and high prevalence in patients with depression may suggest that paracusias are not necessarily a form of migraine aura, though could be a migraine trait symptom. Alternative mechanisms include perfusion changes in primary auditory cortex, serotonin-related ictal perceptual changes, or a release phenomenon in the setting of phonophobia with avoidance of a noisy environment.

Keywords: Auditory; aura; hallucination; headache; migraine; paracusias.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Female
  • Hallucinations / diagnosis*
  • Hallucinations / epidemiology*
  • Humans
  • Male
  • Middle Aged
  • Migraine Disorders / diagnosis*
  • Migraine Disorders / epidemiology*
  • Migraine with Aura / diagnosis
  • Migraine with Aura / epidemiology
  • Retrospective Studies
  • Young Adult