Hemiplegic Migraine Headaches

Hemiplegic migraine is a rare and serious type of migraine headache. Many of its symptoms mimic those common to stroke; for example, muscle weakness can be so extreme that it causes a temporary paralysis on one side of your body, which doctors call hemiplegia.

Symptoms

Sometimes, before the actual headache pain, you'll get other symptoms that it's coming. These early symptoms, called auras, can include short-term trouble with muscle control and sensation:

  • Severe, throbbing pain, often on one side of your head
  • A pins-and-needles feeling, often moving from your hand up your arm
  • Numbness on one side of your body, which can include your arm, leg, and half of your face
  • Weakness or paralysis on one side of your body
  • Loss of balance and coordination
  • Dizziness or vertigo
  • Nausea and vomiting

You may also have problems with your senses, communication, and drowsiness:

  • Seeing zigzag lines, double vision, or blind spots
  • Extreme sensitivity to light, sound, and smell
  • Language difficulties, such as mixing words or trouble remembering a word
  • Slurred speech
  • Confusion
  • Loss of consciousness

Auras usually come on gradually over a half hour and then can last for hours and then slowly resolve. They can be more severe and last longer than with other types of migraine.

The stroke-like symptoms can range from worrisome to disabling. Unlike a stroke, they come on slowly and build and then may completely go away. Muscle problems usually go away within 24 hours, but they may last a few days.

There's not a predictable pattern with this type of migraine. Usually pain follows the paralysis, but it might come before, or you might not get a headache at all. You may hurt a lot and feel only a little weak; then the next attack might bring severe paralysis without much pain.

It's uncommon, but over time, some people can have long-lasting trouble with movement and coordination.

Hemiplegic migraine symptoms often start when you're a child or teen. Sometimes, they'll disappear when you're an adult.

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What Causes Them?

So far, researchers have found four genes linked with hemiplegic migraine:

  • CACNA1A
  • ATP1A2
  • SCN1A
  • PRRT2

Defects, or mutations, in any of these lead to a breakdown in your body's ability to make a certain protein. Without it, nerve cells have trouble sending out or taking in signals that go between them. One of these chemical messengers, or neurotransmitters, is serotonin.

A child of a parent with hemiplegic migraines will have a 50% chance of getting them as well.

Medical Tests to Diagnose

Get emergency medical help right away if you have any of these symptoms. Do not assume that you are having a hemiplegic migraine. It could be a stroke.

A CT scan or an MRI of your head can show signs of a stroke. Tests of your heart and the blood vessels in your neck can rule out symptoms caused by blood clots.

If you have a family member with similar symptoms, your doctor may want to do genetic testing. Familial hemiplegic migraine (FHM) means it runs in your family, and you could pass it on to your children. People who don't have problems with those four genes have sporadic hemiplegic migraine (SHM).

Treatment

Doctors disagree over how to treat hemiplegic migraines.

Your doctor might prescribe drugs to prevent hemiplegic migraine, to stop them once they've started, and to relieve your symptoms. Your doctor will discuss the best options for you.

There is controversy over whether some drugs that are used to treat other types of migraines should be used for hemiplegic migraines.. There is anecdotal evidence that triptans, beta blockers, and ergotamine derivatives may lead to ischemia in patients to treat patients with hemiplegic migraine.

CGRP inhibitors are a new class of preventive medicine for treating most common migraines, but indications suggest this treatment would not be effective for hemiplegic migraines.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 14, 2020

Sources

SOURCES: 

National Headache Foundation: "Hemiplegic Migraines;" "Headache Topic Sheets: Hemiplegic Migraine;" and "Hemiplegic Migraine: An Unusual Type of Migraine with Aura."

National Library of Medicine: "Familial Hemiplegic Migraine," "Migraine with Aura."

Emedicine.com: "Pathophysiology and Treatment of Migraine and Related Headache."

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