Hemiplegic migraine is a rare type of migraine.
Like other types of migraine, hemiplegic migraine causes:
- intense and throbbing pain
- sensitivity to light and sound
It can also cause temporary weakness, numbness and tingling, and paralysis on one side of the body.
These symptoms start before the headache. “Hemiplegia” means paralysis.
Aura also includes other sensory problems and trouble speaking. In people with hemiplegic migraine, the weakness or paralysis happens as part of the aura.
There are two types of hemiplegic migraine. Which type you have is based on your family history of migraine:
- Familial hemiplegic migraine (FHM) affects at least two close relatives in the same family. If you have FHM, each of your children has a 50 percent chance of inheriting the condition.
- Sporadic hemiplegic migraine (SHM) affects people who don’t have any family history of the condition.
A hemiplegic migraine causes symptoms like confusion and trouble speaking, which are similar to those of a stroke.
Seeing a neurologist or headache specialist for tests can help you get the right diagnosis and treatment.
Symptoms of hemiplegic migraine can include:
- weakness on one side of your body, including your face, arm, and leg
- numbness or tingling in the affected side of your face or limb
- flashes of light, double vision, or other vision disturbances (aura)
- trouble speaking or slurred speech
- loss of coordination
Rarely, people with hemiplegic migraine have more serious symptoms, such as the following:
- loss of control over movement
- decreased consciousness
- memory loss
The symptoms can last from a few hours to a few days. Memory loss can sometimes continue for months.
Many of the same drugs used to treat regular migraine also work for hemiplegic migraine. Your doctor may prescribe both a preventive and abortive medication.
- onabotulinumtoxinA (Botox)
- CGRP antagonists
- calcium channel blocker (verapamil, specifically)
Abortive medications for acute attacks
- intravenous (IV) medications: magnesium, Toradol, and anti-emetics (Reglan)
- oral medication: nonsteroidal anti-inflammatory drugs (NSAIDS), Ubrelvy, and Nurtec
- selective serotonin receptor agonist (SSRA)
Hemiplegic migraine is caused by changes (mutations) to genes. A few genes have been linked to hemiplegic migraine, including:
Genes carry the instructions for making proteins that help nerve cells communicate. Mutations in these genes affect the release of brain chemicals called neurotransmitters.
When the genes are mutated, communication between certain nerve cells is interrupted. This can lead to severe headaches and vision disturbances.
In FHM, the gene changes run in families. In SHM, the gene changes happen spontaneously.
Migraine often has triggers specific to you that can cause an attack. Keeping a diary of what you were doing or experiencing prior to each attack can help you narrow them down.
Common triggers of hemiplegic migraine attacks include:
Other migraine triggers include:
- foods such as processed foods, aged cheeses, salty foods, and the additive MSG
- alcohol and caffeine
- skipping meals
- weather changes
Doctors diagnose hemiplegic migraine based on its symptoms.
You’re diagnosed with this type of headache if you’ve had at least two attacks of migraine with aura, weakness, and vision, speech, or language symptoms. These symptoms should go away after your headache improves.
Hemiplegic migraine can be hard to tell apart from other conditions, like stroke or mini-stroke (also called transient ischemic attack). Its symptoms can also be similar to diseases like multiple sclerosis or epilepsy.
To rule out conditions with similar symptoms, your doctor will do tests like these:
- A CT scan uses X-rays to create internal images of your body.
- An MRI uses strong magnets and radio waves to make pictures inside your body.
- An electroencephalogram measures the electrical activity in your brain.
- An echocardiogram uses sound waves to create pictures of your heart.
If you have one or more family members with this type of migraine, you might want to have genetic testing.
However, most people with FHA will not test positive. Researchers have not yet found all the genes linked to this condition.
Attacks of hemiplegic migraine often start in childhood or young adulthood. You’re more likely to have this type of headache if it runs in your family.
If one of your parents has hemiplegic migraine, you have a 50 percent chance of also getting these headaches, according to the Stroke Association.
You may not be able to prevent hemiplegic headaches if they run in your family. However, you can take medication to help reduce the number of headaches you get.
Another way to help prevent these migraine attacks is to avoid any factors that trigger your headaches.
Some people stop getting migraine attacks as they get older. In other people, the condition doesn’t go away.
According to the Stroke Association, having migraine with aura can double your risk for some types of stroke.
The risk increases even more if you smoke or use birth control pills. However, the risk of stroke in general is still pretty low.