Written by Maria Gabrielle, Migraine Health Writer & Researcher
Alice in Wonderland syndrome (AIWS) describes temporary changes in perception. Things may look smaller, larger, closer, further away or oddly shaped. Some people also notice that parts of their body feel unusually large, small or positioned differently in space.
AIWS can feel alarming, particularly the first time it happens. In adults, it is often reported alongside migraine, especially migraine with aura. However, it can also occur with other health conditions, so a new, changing or unusual episode should always be discussed with a healthcare professional.
For plain-English definitions of migraine symptoms and related terms, explore our Migraine A-Z Glossary.
Key takeaways
- AIWS involves temporary distortions in size, distance, body image or time perception.
- It can occur in connection with migraine, but should not automatically be assumed to be a migraine aura.
- New or different neurological symptoms need medical assessment.
- A symptom diary can help identify patterns and support a more useful GP or neurology appointment.
- No food supplement has been shown to diagnose, treat or prevent AIWS.
What is Alice in Wonderland syndrome?
Alice in Wonderland syndrome is a term used for unusual sensory and perception changes. It is named after Lewis Carroll’s story because people may experience changes in how they perceive the size, distance or shape of objects and body parts.
AIWS is not the same as “imagining things” or losing touch with reality. A person may know that an object has not physically changed size, while still experiencing it as visually or spatially distorted. Even so, AIWS should not be self-diagnosed. It is a description of symptoms, not a substitute for medical assessment.
A systematic review of AIWS describes distortions affecting visual perception, body schema and time. Research remains limited, which is one reason new symptoms should be assessed carefully.
Common AIWS symptoms
| Experience | What it may feel like | Helpful note for your diary |
|---|---|---|
| Micropsia | Objects or people appear smaller than they are. | Record what you were looking at and whether both eyes were affected. |
| Macropsia | Objects, body parts or surroundings appear larger than they are. | Note whether the distortion developed gradually or suddenly. |
| Teleopsia | Things appear further away than they really are. | Record the episode start and end time. |
| Pelopsia | Things appear closer than they really are. | Note whether there was a headache, nausea, light sensitivity or dizziness. |
| Body-image distortion | A hand, arm, face or whole body may feel unusually large, small or misplaced. | Record whether there was numbness, weakness or difficulty speaking. |
| Time distortion | Time may seem unusually fast, slow or disconnected from what is happening around you. | Record any fever, infection, medication changes, sleep disruption or migraine symptoms. |
How AIWS may relate to migraine
AIWS is often discussed in relation to migraine because temporary perception changes can occur around a migraine attack. Research suggests that migraine-related changes in brain signalling may affect networks involved in visual, spatial and body-based perception.
A clinical review has proposed that the temporo-parieto-occipital region, where visual and sensory information is integrated, may play a role in AIWS symptoms. The exact mechanism is not fully understood, and evidence is still developing. Read the clinical and pathophysiological review of AIWS.
It is useful to distinguish AIWS from a typical migraine aura. The International Classification of Headache Disorders describes typical aura as fully reversible visual, sensory or speech symptoms that usually develop gradually and last between 5 and 60 minutes. Read the ICHD-3 migraine-with-aura criteria.
For a broader explanation of warning symptoms that can occur before or during an attack, read our guide to migraine aura.
| Feature | AIWS | Typical migraine aura |
|---|---|---|
| Main experience | Changes in perceived size, distance, body image or time. | Visual, sensory or speech-and-language symptoms. |
| Timing | Variable. Record the exact start, end and relationship to other symptoms. | Usually develops gradually and lasts 5 to 60 minutes. |
| Relationship to headache | May happen around a migraine attack, but should not be assumed to be migraine without assessment. | May occur before, during or without a headache. |
| Best next step | Discuss first, changing or concerning episodes with a clinician. | Follow your individual migraine plan and seek advice if symptoms are new or unusual. |
What to do during an AIWS episode
- Get somewhere safe. Sit or lie down, avoid driving and pause any activity that could be unsafe while your perception feels altered.
- Check the time. Make a note of when symptoms started and when they settle.
- Notice accompanying symptoms. Record headache, nausea, light sensitivity, sound sensitivity, numbness, speech changes, dizziness or weakness.
- Use your existing migraine plan. Follow any plan already agreed with your GP, pharmacist or headache specialist.
- Record the context. Note sleep, meals, hydration, stress, menstruation, illness, medication changes and recent head injury where relevant.
- Arrange medical advice. A first episode, changing symptoms or symptoms that do not fit your usual migraine pattern should be assessed.
For broader day-to-day support and information about managing life with migraine, read our comprehensive guide to living with migraines in the UK.
New or different neurological symptoms are always worth checking, even when you have a history of migraine.
How to keep a useful migraine and symptom diary
NICE recommends using a headache diary to support diagnosis and management. Where a diary is used, it should record headache frequency, duration, severity, associated symptoms, medication use, possible triggers and any relationship to menstruation. NICE suggests recording this information for at least 8 weeks. Read NICE guidance on headache diaries and migraine assessment.
For other practical prevention habits to discuss with a healthcare professional, see our Natural Migraine Prevention Guide.
- Date and exact time the perception change began and ended
- Whether symptoms involved one eye, both eyes or body awareness
- What looked or felt different
- Whether you had a headache before, during or after the episode
- Any visual changes, numbness, weakness, speech difficulty or balance problems
- Sleep, stress, food, hydration, alcohol, caffeine, illness or menstrual-cycle context
- Any medicines or supplements taken that day
When to seek medical help
Contact a GP or NHS 111 promptly if this is your first AIWS-like episode, if symptoms are changing, or if they are different from your usual migraine symptoms.
| Situation | What to do |
|---|---|
| Aura-like symptoms last longer than 1 hour, or a migraine attack lasts longer than 72 hours. | Seek urgent advice from your GP or NHS 111. |
| You have motor weakness, double vision, symptoms affecting only one eye, poor balance or reduced consciousness. | Seek urgent medical assessment. |
| You have a sudden, extremely painful headache; loss of vision; confusion; seizure; new weakness on one side; or symptoms after a head injury. | Call 999. |
The NHS migraine guidance explains when to seek urgent or emergency help. Do not drive yourself to A&E if you have serious neurological symptoms.
A note on supplements and AIWS
AIWS should not be self-treated with a food supplement. There is no supplement proven to treat or prevent AIWS, and supplements should never delay assessment of a new neurological symptom.
MigraSoothe products are food supplements, not medicines. They are not intended to diagnose, treat, cure or prevent AIWS, migraine or any other disease. Speak to your GP, neurologist or pharmacist before starting a supplement, especially if you are pregnant, breastfeeding, managing another health condition or taking prescription medication.
For non-medical questions about products, ingredients and ordering, visit our MigraSoothe FAQs.
For general product information, you can view the MigraSoothe range.
Frequently asked questions
What is Alice in Wonderland syndrome?
Alice in Wonderland syndrome, or AIWS, describes temporary changes in how someone perceives size, distance, body image or time. It is a symptom pattern that needs clinical context rather than a diagnosis to make alone.
What can AIWS feel like?
Objects may appear unusually small, large, near or far away. Some people describe body parts feeling the wrong size or position. Time may also feel unusually fast or slow.
Is AIWS the same as migraine aura?
Not necessarily. AIWS can occur around a migraine attack and may overlap with aura-like symptoms, but it should not automatically be assumed to be a typical migraine aura.
Can AIWS happen without a headache?
Yes. Migraine-related neurological symptoms can occur with or without a headache. A clinician can help determine whether an episode is likely to be migraine-related or needs further assessment.
How long do AIWS episodes last?
Timing varies. Record when symptoms begin and end, then discuss the pattern with your GP or specialist. Typical migraine aura symptoms usually last 5 to 60 minutes, but AIWS symptoms do not have one fixed duration.
Is AIWS a mental health condition?
AIWS involves perception changes and does not automatically indicate a mental health condition. However, a healthcare professional should assess new or unusual symptoms and consider the possible cause.
Can anxiety cause AIWS?
Stress and anxiety may be relevant to migraine for some people, but they do not establish the cause of AIWS. Track the circumstances around episodes and discuss them with a clinician.
Who can experience AIWS?
AIWS can occur in children and adults. In adults it is often reported alongside migraine, while clinicians may consider other causes in children and in anyone with new symptoms.
Can supplements treat AIWS?
No supplement has been proven to treat AIWS. Do not use supplements as a replacement for medical assessment or an individual migraine plan.
When should I seek urgent help?
Seek urgent help for first or changing symptoms, symptoms lasting longer than expected, motor weakness, double vision, one-eye symptoms, poor balance, seizure, confusion, sudden severe headache or loss of vision.
Sources and further reading
- Blom JD. Alice in Wonderland syndrome: a systematic review.
- Mastria G et al. Alice in Wonderland Syndrome: A Clinical and Pathophysiological Review.
- International Classification of Headache Disorders: migraine with aura.
- NICE CG150: Headaches in over 12s: diagnosis and management.
- NHS: Migraine.
Medical disclaimer
This article is for general information only and does not replace personalised medical advice. AIWS-like symptoms can have several causes. Speak to a doctor about new, changing or worrying symptoms. MigraSoothe products are food supplements and are not medicines.