Migraine-Like Visual Auras Among Traumatized Cambodians with PTSD: Fear of Ghost Attack and Other Disasters
This article profiles visual auras among traumatized Cambodian refugees attending a psychiatric clinic. Thirty-six percent (54/150) had experienced an aura in the previous 4 weeks, almost always phosphenes (48% [26/54]) or a scintillating scotoma (74% [40/54]). Aura and PTSD were highly associated: patients with visual aura in the last month had greater PTSD severity, 3.6 (SD = 1.8) versus 1.9 (SD = 1.6), t = 10.2 (df = 85), p < 0.001, and patients with PTSD had a higher rate of visual aura in the last month, 69% (22/32) versus 13% (7/55), odds ratio 15.1 (5.1–44.9), p < 0.001. Patients often had a visual aura triggered by rising up to the upright from a lying or sitting position, i.e., orthostasis, with the most common sequence being an aura triggered upon orthostasis during a migraine, experienced by 60% of those with aura. The visual aura was often catastrophically interpreted: as the dangerous assault of a supernatural being, most commonly the ghost of someone who died in the Pol Pot period. Aura often triggered flashback. Illustrative cases are provided. The article suggests the existence of local biocultural ontologies of trauma as evinced by the centrality of visual auras among Cambodian refugees.
KeywordsAura Migraine PTSD Panic Culture Complex trauma
Compliance with Ethical Standards
Conflict of interest
The authors have no conflicts of interest.
The study was conducted as per in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants.
- Becker, Elizabeth 1998 When the War Was Over: Cambodia and the Khmer Rouge Revolution. New York: Public Affairs.Google Scholar
- Chandler, David P. 1991 The Land and People of Cambodia. New York: Lippincott.Google Scholar
- Farmer, P. 1997 On Suffering and Structural Violence: A View from Below. In Social Suffering. A. Kleinman, V. Das, and M. Lock, eds., pp. 261–284. Berkeley: University of California.Google Scholar
- Gustafsson, Mai Lan 2009 War and Shadows: The Haunting of Vietnam. Ithaca: Cornell University Press.Google Scholar
- Hinton, D.E., and B.J. Good 2016a The Culturally Sensitive Assessment of Trauma: Eleven Analytic Perspectives, a Typology of Errors, and the Multiplex Models of Distress Generation. In Culture and PTSD: Trauma in Historical and Global Perspective. D.E. Hinton, and B.J. Good, eds., pp. 50–113. Pennsylvenia: University of Pennsylvenia Press.Google Scholar
- Hinton, D.E., and B.J. Good, eds. 2016b Culture and PTSD: Trauma in Historical and Global Perspective. Pennsylvenia: University of Pennsylvenia Press.Google Scholar
- Hinton, D.E., A. Hinton, D. Chhean, V. Pich, J.R. Loeum, and M.H. Pollack 2009a Nightmares among Cambodian Refugees: The Breaching of Concentric Ontological Security. Culture, Medicine, and Psychiatry 33:219–265.Google Scholar
- Hinton, D.E., A.L. Hinton, K.-T. Eng, and S. Choung 2012 PTSD and Key Somatic Complaints and Cultural Syndromes among Rural Cambodians: The Results of a Needs Assessment Survey. Medical Anthropology Quarterly 29:147–154.Google Scholar
- Hinton, D.E., S.G. Hofmann, S.P. Orr, R.K. Pitman, M.H. Pollack, and N. Pole 2010 A Psychobiocultural Model of Orthostatic Panic among Cambodian Refugees: Flashbacks, Catastrophic Cognitions, and Reduced Orthostatic Blood-Pressure Response. Psychological Trauma: Theory, Research, Practice, and Policy 2:63–70.CrossRefGoogle Scholar
- Hinton, D.E., A. Rasmussen, L. Nou, M.H. Pollack, and M.J. Good 2009b Anger, PTSD, and the Nuclear Family: A Study of Cambodian Refugees. Social Science and Medicine 69:1387–1394.Google Scholar
- Lipton, R.B., M.E. Bigal, M. Diamond, F. Freitag, M.L. Reed, W.F. Stewart, and Ampp Advisory Group 2007 Migraine Prevalence, Disease Burden, and the Need for Preventive Therapy. Neurology 68(5):343–349.Google Scholar
- Peroutka, S.J. 2004a Migraine: A Chronic Sympathetic Nervous System Disorder. Headache 44(1):53–64.Google Scholar
- Peroutka, S.J. 2004b Re: A Sympathetic View of “2003 Wolff Award: Possible Parasympathetic Contributions to Peripheral and Central Sensitization During Migraine”. Headache 44(7):731–732.Google Scholar
- Sacks, O.W. 1999 Migraine. New York: Vintage Books.Google Scholar