Hemiplegic migraine is a rare type of migraine with an unusual 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 other factors, like a family history of the condition, can also increase your risk.
Symptoms of hemiplegic migraine can resemble those of a stroke, so accurate diagnosis is important.
It’s also important to distinguish hemiplegic migraine from other migraine types, as some common migraine medications are not recommended for people with hemiplegic migraine.
Doctors categorize hemiplegic migraine into two primary types. Your family history of migraine helps doctors determine which type to diagnose:
- 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.
There are also several subtypes of FHM, depending on the specific gene mutation linked to the condition (FHM1, FHM2, FHM3) or if doctors can’t identify a known gene mutation (FHM4).
Like other types of migraine, hemiplegic migraine can cause:
- intense and throbbing pain
- nausea
- sensitivity to light and sound
As a type of migraine with aura, hemiplegic migraine also includes an “aura” phase that can feature visual symptoms, like flashes of light and zigzag patterns, that happen before or during a migraine episode.
Aura can also include other sensory problems, like tingling in the fingers or difficulty speaking.
The defining features of hemiplegic migraine are motor symptoms, such as temporary weakness, numbness and tingling, and paralysis on one side of the body. “Hemiplegia” means paralysis.
Symptoms of hemiplegic migraine typically start before the headache and can
- 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
- 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 difficulty concentrating can sometimes continue for months.
When to seek medical help
If you’re experiencing severe headaches or migraine attacks, it’s good to talk with your doctor about a treatment plan. Call 911 or your local emergency services 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’re unsure what’s causing your symptoms, seek medical care.
Doctors diagnose hemiplegic migraine based on its symptoms. Seeing a neurologist or headache specialist for tests can help you get the correct diagnosis and treatment.
According to the International Classification of Headache Disorders 3rd edition (ICHD-3), to receive a diagnosis of hemiplegic migraine, you must have:
- at least two attacks of migraine with aura
- aura must include motor weakness and vision, speech, or language symptoms
- symptoms should go away after your headache improves
It can be challenging to distinguish hemiplegic migraine 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, a doctor will order tests, such as:
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 for a known gene mutation. Researchers have not yet found all the genes with links to FHM.
Many of the same medications used to treat classic migraine also work for hemiplegic migraine, with a few notable exceptions.
A doctor may prescribe both a preventive and abortive medication. Preventive medications for migraine aim to prevent episodes before they happen, while abortive medications help stop an episode as it’s happening.
Preventive medications
Preventive medications for hemiplegic migraine include:
- CGRP antagonists
- anticonvulsants, like topiramate (Topamax)
- calcium channel blockers, like verapamil
- antidepressants
- onabotulinumtoxinA (Botox)
Beta-blockers are also a common preventive medication for people with migraine. However,
Abortive medications for acute attacks
Abortive medications for acute migraine attacks include:
- antiemetic drugs, like metaclopramide (Reglan)
- intranasal (through the nose) ketamine
- nonsteroidal anti-inflammatory drugs (NSAIDs)
Experts don’t recommend some common abortive migraine medications, like triptans and ergotamines, as they may increase the risk of stroke and similar conditions.
Research links mutations (changes) in specific genes to hemiplegic migraine. Genes linked to FHM
- ATP1A2
- CACNA1A
- 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. This interrupts communication between certain nerve cells, which can lead to severe headaches and vision disturbances.
In FHM, gene changes run in families when a parent passes them down 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.
Triggers for hemiplegic migraine may
- stress
- lack of sleep or too much sleep
- intense emotions
- physical exertion
- head trauma
- bright lights
- conventional angiography
According to the National Organization for Rare Disorders, attacks of hemiplegic migraine often start in childhood or young adulthood. The condition is also more common in females.
You’re more likely to have hemiplegic migraine if it runs in your family. FHM follows an autosomal dominant inheritance pattern. That means a parent with the condition has a 50% chance of passing it on to their child.
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.
Some people stop getting migraine attacks as they get older. In other people, the condition doesn’t go away.
How rare is hemiplegic migraine?
Migraine affects
How long does it take to recover from a hemiplegic migraine episode?
Hemiplegic migraine attacks can last several hours or days. In some cases, lingering effects, such as brain fog and low energy, can even last for months.
Should I go to the ER for a hemiplegic migraine?
Symptoms of hemiplegic migraine often resemble those of a stroke. Call 911 or your local emergency services if you notice emergency stroke symptoms.
If a doctor arrives at a diagnosis of hemiplegic migraine, you can discuss a plan with them so you know what to do if your symptoms recur.
How can I tell the difference between a hemiplegic migraine and a stroke?
Hemiplegic migraine symptoms usually come on slowly, over
Learn more: “How to Tell the Difference Between Migraine and Stroke”
Can hemiplegic migraine lead to stroke?
Hemiplegic migraine attacks have similar symptoms to a stroke, but it does not cause a stroke. However, there may be other links between stroke and migraine aura more generally.
Is hemiplegic migraine a disability?
In addition to head pain and motor weakness, some cases of hemiplegic migraine can cause lingering effects, like brain fog and fatigue. If symptoms or complications of hemiplegic migraine hinder your ability to work, you may be eligible for disability benefits.
Learn more: “Can You Apply for Disability Benefits Due to Migraine?”
Hemiplegic migraine doesn’t just cause headache pain — it can also cause temporary weakness or paralysis on one side of your body. It’s a rare type of migraine with aura and your risk may be higher if you have a family history of the condition.
Symptoms of hemiplegic migraine may resemble a stroke or ministroke. Seeking immediate medical attention for symptoms like sudden weakness or slurred speech can help ensure you receive prompt treatment for the correct condition.