Migraine episodes may begin with visual and sensory disturbances known as auras, often followed by headaches. These episodes can also involve hallucinations.

Although migraine often involves painful headaches, a migraine is a unique neurological condition with its own set of symptoms.

Researchers aren’t quite sure what causes migraines, but there is a strong genetic component. Imbalances in the hormone estrogen may also be involved, as women are three times more likely to suffer from migraines than men.

A migraine episode, or attack, is sometimes preceded by sensory disturbances called auras. A migraine with aura is also called a classic migraine.

Sensory symptoms of auras may include:

  • sensitivity to light, sound, and smells
  • nausea and vomiting
  • tingling of the hands and feet
  • seeing shimmering lights

Although uncommon, migraines can also cause different types of hallucinations. But they typically aren’t considered to be symptoms of auras.

Olfactory hallucinations, also known as phantosmia, refer to experiencing smells that aren’t there. They can occur during migraine attacks, although they’re extremely rare and only occur in around 0.1% of adults with migraines.

Olfactory hallucinations typically occur just before or during a migraine headache and usually only last up to 10 minutes. But in a small percentage of people, they can last many hours.

Patients often describe the odors as being specific and very unpleasant. The most common aroma reported is a burning smell. Other smells, including vanilla, gasoline, and coffee, are also common. Most patients experience the same odor every time they have a migraine attack.

Researchers believe abnormal activation of the neurons in the olfactory cortex, the part of the brain that processes smells, causes olfactory hallucinations.

While some evidence suggests a link between olfactory hallucinations and auras, this hasn’t been confirmed, and hallucinations can occur in people without aura symptoms.

Although visual auras are relatively common in migraine patients, they’re distinct from visual hallucinations. Visual auras are simple visual disturbances like flashes of light or zig-zagging lines.

On the other hand, visual hallucinations are much more complex and include vivid images of people, animals, or objects that appear to actually exist. They generally arise from visual symptoms of auras.

Like olfactory hallucinations, visual hallucinations are very rare in migraine patients, according to a 2021 study. But the exact prevalence isn’t known. They’re primarily in patients with familial hemiplegic migraine, a rare type of inherited migraine that causes weakness in one side of the body.

It’s likely visual hallucinations during migraines are caused by a wave of brain activity that spreads across the visual cortex.

This causes the neurons in the visual cortex to “misfire,” which the brain interprets as seeing real people or other images when there are none. Research states that this same phenomenon could also cause visual symptoms of auras.

Migraines can also cause auditory hallucinations. These occur when a person hears sounds or voices that aren’t there.

Most of the time, they occur during a migraine headache and usually last less than an hour. They tend to disappear as soon as the headache goes away.

Auditory hallucinations typically involve unfamiliar human voices. Common sounds may also include:

  • crickets
  • white noise
  • bells ringing
  • constant beeping

They’re much more common in migraine patients with depression. But the reason for this is unknown.

Researchers believe changes in blood flow to the auditory cortex, the part of the brain that processes sound, partly causes auditory hallucinations. It may also be caused by imbalances in the neurotransmitter serotonin and abnormal brain activity in the auditory cortex.

Unlike visual hallucinations, there’s no link between auditory hallucinations and auras.

You should see a doctor if you’re experiencing hallucinations during your migraine episode. Hallucinations may be a sign of other serious medical conditions.

You should seek immediate medical attention if you have severe migraine symptoms, including:

  • neck stiffness
  • fever
  • trouble speaking
  • numbness
  • a migraine headache that quickly develops within seconds

Your doctor will order diagnostic tests, including blood, urine, and brain imaging tests such as an MRI or CT scan, to help rule out other possible causes of your hallucinations.

These tests will help them tell if your hallucinations are due to migraine or are a sign of another medical condition. If they determine your hallucinations are a symptom of migraine, they can provide treatments to help prevent and treat them.

These include:

  • blood pressure-lowering medications, including beta-blockers (propranolol)
  • anti-seizure drugs, including valproate and topiramate
  • amitriptyline, an antidepressant drug
  • botox injections

To help relieve pain, your doctor may have you take aspirin and NSAIDs like ibuprofen (Advil) and naproxen (Aleve). They may also prescribe certain medications, including:

  • triptans, such as sumatriptan (imitrex)
  • anti-nausea drugs
  • CGRP antagonists, such as ubrogepant (ubrelvy)
  • opioids for people who are unable to take other pain medications

It’s best to take these at the first sign of migraine symptoms.

Migraine is a common condition that can involve sensory disturbances called auras. More rarely, they’re associated with complex hallucinations involving smell, sight, and sound.

Research shows similar mechanisms may underlie symptoms of aura and olfactory and visual hallucinations.

One mechanism that explains both is waves of brain activity that “excite” neurons in the parts of the brain that process smell, vision, and sound. But certain hallucinations may also occur without aura symptoms.

Identifying your migraine triggers can help you prevent the occurrence of a migraine attack. Common triggers include certain foods, poor sleep, and stress.

To help determine your migraine triggers, try keeping a journal to track when your migraine symptoms occur.

Consider writing down what you were doing right before your migraine episode started. Also, try to note your sleeping habits, diet, and stress levels in the days leading to an attack.