32Background: Near-death experiences (NDE) occur with imminent death and in situations of 33 stress and danger but are poorly understood. Evidence suggests that NDE are associated with 34 rapid eye movement (REM) sleep intrusion, a feature of narcolepsy. Previous studies further 35 found REM abnormalities and an increased frequency of dream-enacting behavior in migraine 36 patients, as well as an association between migraine with aura and narcolepsy. We therefore 37 investigated if NDE are more common in people with migraine aura. 38 Methods: We recruited 1037 laypeople from 35 countries via a crowdsourcing platform. Reports 39 were validated using the Greyson NDE Scale.40Results: Eighty-one of 1037 participants had NDE (7.8%; CI 6.3-9.7%). There were no 41 significant associations between NDE and age (p>0.6, t-test independent samples) or gender 42 (p>0.9, chi-square test). The only significant association was between NDE and migraine aura: 43Forty-eight (6.1%) of 783 subjects without migraine aura and 33 (13.0%) of 254 subjects with 44 migraine aura had NDE (p<0.001, chi-square test, odds ratio (OR) = 2.29). In multiple logistic 45 regression analysis, migraine aura remained significant after adjustment for age (p0.001, OR 46 2.31), gender (p<0.001, OR 2.33), or both (p<0.001, OR 2.33). 47 Conclusions: In our sample, migraine aura was a predictor of NDE. This indirectly supports the 48 association between NDE and REM intrusion and might have implications for the understanding 49 of NDE, because a variant of spreading depolarization (SD), terminal SD, occurs in humans at 50 3 the end of life, while a short-lasting variant of SD is considered the pathophysiological correlate 51 of migraine aura. 52 53 Introduction 54 55 Near-death experiences (NDE) include emotional, self-related, spiritual and mystical perceptions 56 and feelings, occurring in situations close to death or in other situations of imminent physical or 57 emotional danger (Greyson, 1983; Parnia et al., 2014). Common themes of NDE comprise, but 58 are not restricted to, out-of-body experiences, visual and auditory hallucinations and distortion of 59 time perception, including increased speed of thoughts (Greyson, 1983). 60 The neuronal mechanisms of NDE are poorly understood (Peinkhofer, Dreier & Kondziella, 61 2019). Nelson and colleagues previously proposed the concept that rapid eye movement (REM) 62 sleep intrusion and REM related out-of-body experiences could occur at the time of a life-63 threatening event and might explain many elements of NDE (Nelson et al., 2006; Nelson, 64 Mattingly & Schmitt, 2007). REM sleep is defined by rapid and random saccadic eye 65 movements, loss of muscle tone, vivid dreaming, and cortical activation as revealed by 66 desynchronization of the scalp electroencephalography (EEG). REM state features can intrude 67 into wakefulness, both in healthy individuals and patients with narcolepsy. This may cause visual 68 and auditory hallucinations at sleep onset (hypnagogic) or upon awakening (hypnopompic) and 69 muscle...