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.
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
- Loss of consciousness or coma (rare)
Auras usually come on gradually over a half hour and then can last for hours to 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.
What Causes Them?
So far, researchers have found four genes linked with hemiplegic migraine:
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.
About half of the people with hemiplegic migraine inherited the genes from a parent with the condition.
Medical Tests to Diagnose
See your doctor for a full exam to figure out what's going on.
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 three genes have sporadic hemiplegic migraine (SHM).
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.
Some doctors are feeling more comfortable that drugs called triptans, which are used for migraine headaches, are safe and effective for relieving hemiplegic migraine when you get them, too. Still, they are contraindicated based on package labelling. 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.