Can migraine attacks make you feel like you don’t even exist?
Open and thorough patient and doctor communication is important in establishing an accurate diagnosis and management plan. It can even help identify rare or complex manifestations of migraine such as Cotard’s syndrome — a feeling that one does not exist — that might otherwise be mistaken for completely different neurological conditions.
“The other thing you want to do is ask them, ‘Did anything peculiar ever happen during a migraine?’ This produces a pause, and they say, ‘Like what?’ ‘Something really strange that you wouldn't want to tell your friends or a doctor.’ I had one woman with chronic migraine, she said, ‘Yes.’ ‘What was that?’ ‘I thought I was dead.’ ‘Yes, I died, I went to my funeral, my husband was there watching it, and this death lasted for about a week.’ I said, ‘That's interesting but obviously you weren't dead.’ Well it's very interesting if you go back in the literature, a French neurologist called Cotard, C-O-T-A-R-D, you can Google him and
YouTube, describe the possibility that if the migraine aura involved the parietal cortex — not just the visual area for loss of vision, or the sensory strip for loss of numbness, right? Then you could get this, what he called, the delirium de négation, the feeling that you didn't
exist. He predicted it should occur in migraine, but he didn't have any cases. Well I had two.
Cotard’s syndrome is a rare manifestation of parietal involvement in a very complex migraine situation. What she was telling me was migraine. Now if I didn't know that, I would ascribe it to something else. In fact, her imaging suggested she may have a stroke and she was treated as a stroke, but ultimately the imaging showed that stroke went away, it never was there. It was always migraine.”
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Allan Purdy, MD
Professor of Neurology
Dalhousie University, Canada
Dr. Allan Purdy is a neurologist and a professor at Dalhousie University in Nova Scotia, Canada. Dr. Purdy is currently President of the American Headache Society. He has also served as president of the Canadian Headache Society and on the Board of Directors for the International Headache Society.
Dr. Purdy is regarded as one of the most gifted teachers in the field, developing educational programs for physicians around the world who care for patients with headache diseases. In addition to his research and education work, Dr. Purdy continues to see headache patients in his Canadian clinic on a part-time basis.