Persistent Derealization and Depersonalization
Type: Persistent aura symptom — may last weeks, months, or years. Often bilateral (affecting both sides of vision or both ears). Rare but well-documented.
What is it?
Derealization is a persistent feeling that the world around you is unreal, dreamlike, or distant, as though you are viewing life through a screen. Depersonalization is a persistent feeling of detachment from your own body, thoughts, or emotions, as though you are observing yourself from outside. These dissociative experiences do not resolve after the aura episode ends.
What it feels like
With derealization, the world feels strange or artificial—buildings, people, and objects seem two-dimensional or distant, as though you are in a dream. Colors may seem muted or unreal. Familiar places feel unfamiliar. Time may feel distorted. With depersonalization, you feel disconnected from your own body or mind. You may observe your own actions as though you are outside yourself. Your hands or other body parts may feel unfamiliar or distant. Emotions may feel muted or absent. These experiences can be disturbing and frightening, creating a sense of alienation or unreality that persists even when you are not having a migraine.
How patients describe it
“My migraine experience starts with hunger. I suddenly feel hungry. Shortly after that my vision becomes ‘distant’. It is somewhat like seeing the world projected on a screen.” — A.W.
“I get derealization/depersonalization when I have a migraine…” — J.
“By the way I have a combined form of migraine. Classic and basilar. I suffer from depersonalization to begin with, aura, up to complete blindness, pareses, speech losses, etc.” — I.
What makes it worse
Derealization and depersonalization often worsen during or shortly after migraine attacks. Stress, anxiety, and panic can intensify dissociative feelings. Fatigue and lack of sleep may exacerbate symptoms. Focusing attention on the symptoms themselves or worrying about them can create a cycle of worsening. Some patients report worsening in busy or overstimulating environments. Alcohol and caffeine may worsen symptoms in some cases.
What may help
Grounding techniques—focusing on sensory input (touch, smell, taste, sound) to anchor yourself in the present—help many people manage dissociative experiences. Mindfulness and acceptance-based approaches can reduce distress associated with the symptoms. Cognitive behavioural therapy specifically addressing dissociative symptoms has shown benefit. Stress reduction, regular sleep, and avoiding overstimulation help some patients. Physical activity and social connection support mental health. Some patients find that talking with others who have similar experiences reduces isolation.
Related symptoms
- Anxiety or panic attacks
- Cognitive problems or brain fog
- Body image disturbances (Alice in Wonderland syndrome)
- Time perception disturbances
Clinical note
Derealization is reported by 8 of 60 subjects, and depersonalization by 3 of 60 subjects with definite persistent aura. These symptoms can be distressing and may resemble psychiatric conditions, but they are well-documented as aura symptoms. Evaluation by a neurologist and mental health professional is important to confirm the diagnosis and rule out primary psychiatric disorders. A normal brain MRI and EEG help support the diagnosis of persistent aura without infarction. These symptoms are treatable with appropriate support and therapy.
If this is the first time you experience these symptoms, or they feel different from previous episodes, seek medical evaluation to rule out other causes.