On Singh’s mysterious mirror-induced headaches: Towards explanation

We highlight and summarize a rare case of a mirror-induced headache reported by Singh (2018). A female patient experienced acute bi-temporal headaches within minutes of viewing her own reflection in mirrors or other reflective surfaces. A series of comprehensive neurological, psychiatric, and imaging assessments did not identify the reason behind it. Treatment with propranolol and amitriptyline, combined with gradual exposure to the mirror trigger, led to a complete symptom resolution within four months. Singh proposed visual cortex hyperexcitability, particularly overactivation of facial recognition areas, as the most plausible mechanism. We expand on this explanation using evidence from research on aniseikonia, transformed environments through prismatic glasses, and our own studies of “Expectancy Violation Headaches” induced by altered familiar video game environments. We argue that expertise and familiarity can amplify sensitivity to subtle visual mismatches, triggering migraine-like symptoms. Recognizing objects of expertise that may act as atypical triggers and progressively exposing the patient to them, combined with the appropriate pharmacological treatment may completely eliminate them.