Hemiplegic migraine is a rare but severe type of migraine with aura that often runs in families. Symptoms can range from weakness to temporary paralysis.

A hemiplegic migraine is a rare type of migraine that can cause weakness or even paralysis on one side of the body. People who have migraine with aura are more prone to these types of headaches, but there are other factors that can increase your risk, too.

This article will explore hemiplegic migraine, how common they are, who gets them, and how they’re treated.

Migraine affects 15–20% of people, but hemiplegic migraine makes up less than 1% of these cases. This rare variety of migraine with aura can include visual symptoms, like flashes of light and zigzag patterns, that happen before or during a migraine episode.

Like other types of migraine, hemiplegic migraine causes:

  • intense and throbbing pain
  • nausea
  • 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.

According to the National Headache Foundation, hemiplegic migraine affects a small number of people who get migraine with aura. Aura includes visual symptoms, like flashes of light and zigzag patterns, that happen before or during a migraine attack.

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). This type affects at least two close relatives in the same family. If you have FHM, each of your children has a 50% chance of inheriting the condition.
  • Sporadic hemiplegic migraine (SHM). SHM affects people who don’t have any family history of the condition.

A hemiplegic migraine episode 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
  • drowsiness
  • dizziness
  • loss of coordination

In rare cases, people with hemiplegic migraine have more serious symptoms, like:

  • confusion
  • loss of control over movement
  • decreased consciousness
  • memory loss
  • coma

The symptoms can last from a few hours to a few days, but memory loss can sometimes continue for months.

When to seek medical help

If you are experiencing severe headaches or migraine, it’s good to talk with your doctor about a treatment plan. Call 911 or seek emergency care if you experience things like:

  • slurred speech
  • sudden weakness
  • loss of consciousness
  • confusion

The symptoms of hemiplegic migraine are similar to those of a stroke, which requires immediate medical treatment. If you are unsure what is causing your symptoms, don’t hesitate to seek medical care.

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Many of the same drugs used to treat classic migraine also work for hemiplegic migraine. Your doctor may prescribe both a preventive and abortive medication. Preventive medications for migraine are meant to prevent migraine headaches before they happen, and abortive medications help stop a migraine episode as it‘s happening.

Preventive medications

Preventive migraine medications include:

Abortive medications for acute attacks

Abortive medications for acute (episodic) migraine attacks include:

Hemiplegic migraine is caused by changes or mutations in your genes. A few genes have been linked to hemiplegic migraine, including:

  • ATP1A2
  • PRRT2
  • SCN1A

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, gene changes run in families and are passed down from parents to their children. In SHM, these 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 down your triggers.

Common triggers of hemiplegic migraine include:

Other migraine triggers include:

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 ministroke (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:

  • CT scan. A CT scan uses X-rays to create internal images of your body.
  • MRI scan. An MRI scan uses strong magnets and radio waves to make pictures of the inside of your body.
  • Electroencephalogram (EEG). An EEG measures the electrical activity in your brain.
  • Echocardiogram. 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 FHM will not test positive. Researchers have not yet found all the genes linked to this condition.

According to the National Headache Foundation, 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% chance of also getting these headaches, according to the Stroke Association.

In addition, having migraine with aura can double your risk of 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.

You may not be able to prevent hemiplegic migraine attacks 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.

What’s the best way to stop a hemiplegic migraine?

Pain medications like NSAIDs can help stop a hemiplegic migraine episode. Other medications used to stop migraine episodes include intravenous magnesium and Reglan.

How long does it take to recover from a hemiplegic migraine?

Hemiplegic migraine attacks can last several hours or days. In some cases, side effects of these migraine attacks like memory loss can even last for months.

Can hemiplegic migraine lead to stroke?

Hemiplegic migraine attacks have similar symptoms to a stroke, but it does not cause a stroke. It is possible that these two issues may be linked in some way and occur around the same time. If you experience symptoms of weakness and difficulty speaking, seek help immediately.

What foods should I eat with a hemiplegic migraine?

Foods that are rich in magnesium and omega-3 fatty acids are believed to help prevent hemiplegic migraine episodes.

What foods should I avoid if I have hemiplegic migraine?

Known food triggers for many people with migraine include:

  • processed foods
  • foods rich in nitrates
  • chocolate
  • caffeine
  • alcohol
  • foods that contain MSG

Hemiplegic migraine doesn‘t just cause severe headache pain — it can lead to weakness or paralysis on one side of your body, too.

While hemiplegic migraine isn‘t linked to stroke exactly, the symptoms are so similar that it’s a good idea to seek medical attention for symptoms like sudden weakness or slurred speech.

If you have a history of this type of migraine, work with a doctor to create a treatment plan that can help you relieve and prevent symptoms.