Alice in Wonderland syndrome (AIWS for short) is where objects, and even parts of the body, can appear to be much smaller or much bigger than they really are. These impressions of distorted size can last for many minutes, and sometimes longer. This is much as Alice found herself to be in Lewis Carroll’s books – hence the name. In fact, based on his diary entries, it has been hypothesized that Carroll himself suffered from migraines and may have experienced the sensory distortions which characterise the syndrome.
Although not actually a migraine syndrome, it’s worth talking about Alice in Wonderland syndrome here because so many of its symptoms are like those of a migraine aura. AIWS can also accompany migraines as one part of a migraine aura, or it can happen during the headache phase of a migraine attack, or even both. In a situation where no head pain is experienced, but other migraine symptoms and AIWS are, it may be part of what is commonly referred to as a “silent” migraine.
Although it was first described in 1952, and named in 1955 by the English psychiatrist John Todd, not that much is known about what causes AIWS, but it may stem from disruption to the parieto-occipital part of the brain. The parietal part of the brain is what deals with perception of space and the body, while the occipital area is what deals with vision.
This would tie in with why migraine auras might involve AIWS – since cortical spreading depression (CSD), which has been thought to cause migraine aura symptoms, moves through the brain during a migraine aura and disrupts different senses in turn and so resulting in symptoms such as seeing flashing lights and having difficulty speaking.