Everything You Need to Know About Hemiplegic Migraine

What is a Hemiplegic Migraine? 

A hemiplegic migraine is a rare migraine that is accompanied by weakness in one side of the body. This type of migraine might come with stroke-like symptoms and, in more extreme cases, leads to unilateral paralysis called “hemiplegia”. Although hemiplegic migraines are more commonly associated with motor symptoms, they can come with other aura symptoms as well. Aura symptoms are usually visual, sensory, motor, or verbal disturbances. One is more prone to hemiplegic migraines if they have a family history of the condition (familial hemiplegic migraine); though, it can occur without any genetic predisposition as well (sporadic hemiplegic migraine). 

Hemiplegic Migraine Types

There are two types of hemiplegic migraines: 

• Sporadic Hemiplegic Migraines (SHM): Involves hemiplegic migraine symptoms with no prior family history of hemiplegic migraines. 
• Familial Hemiplegic Migraines (FHM): Diagnostic criteria require that a first-degree or second-degree relative was previously diagnosed with hemiplegic migraines. 

Hemiplegic Migraine Symptoms

Hemiplegic migraines are most notably marked by two phases: the aura phase and the headache phase. Auras usually last up to an hour but, in rare cases, can last up to a week. Auras precede the headache phase but might occur alongside headaches or outlast the headache as well. Hemiplegic migraine symptoms include: 

• Hemiplegia (weakness or paralysis in one side of the body): Weakness or paralysis might be felt on one half of the body or in certain parts, like hands, arms, legs, or face. 
• Aura symptoms: Commonly associated with motor disturbances, hemiplegic migraines are often accompanied by visual disturbances like blind spots (scotoma), flashing lights, or blurry vision, in addition to other motor disturbances like numbness, tingling (paresthesia), or pins and needles. 
• Fever, lethargy, or drowsiness: Hemiplegic migraines can be uncomfortable and incapacitating due to their effects on energy levels. 
• Intense headaches: Although common in most migraines, people are prone to experiencing throbbing and intense headaches in the case of hemiplegic migraine. The intensity of the headache is often associated with sensitivity to light and sound. 
• Nausea and vomiting: Often a byproduct of the intense pain that many with hemiplegic migraines experience. 
• Imbalance: Some people experience a certain level of spatial disorientation, resulting in a loss of balance. 
• Severe and rare symptoms: Confusion, memory loss, seizures, and prolonged weakness. In extremely rare cases, hemiplegic migraines can result in a coma.

Hemiplegic Migraine Causes and Triggers

Hemiplegic migraines, both sporadic and familial, are thought to be caused by genetic mutations and anomalies, namely in four genes (CACNA1A, ATP1A2, SCN1A, and PRRT2). These genes are crucial for neurotransmission and signalling. Familial hemiplegic migraines are hereditary whereas sporadic hemiplegic migraines are not. Certain foods might trigger these migraines too, including alcohol, cheese, chocolate, many types of meat, and pickles. 

Treating Hemiplegic Migraines

Hemiplegic migraine treatments are similar to other migraine treatments. There are some medications however that are used less frequently in cases of hemiplegic migraines. Triptans and beta-blockers constrict blood vessels, increasing the chance of strokes, something people with hemiplegic migraines are potentially at risk of. There are prophylactic treatments, those which aren’t used during a migraine attack but instead used to prevent the development of migraine. There are also symptom management and acute treatment options – medications used at the onset of or during a migraine attack to reduce the intensity of the symptoms. 

Preventive treatments for hemiplegic migraines include botox, anti-seizure medications, calcium channel blockers, and CGRP inhibitors. Symptom management treatments include NSAIDs (like Aspirin, paracetamol, and naproxen), triptans, antiemetics (like metoclopramide), and anti-seizure medication. Though there is limited evidence to suggest diets can help prevent or treat migraines, avoiding trigger foods is wise. A hemiplegic migraine diet would include foods rich in omega-3 fats, bread, fresh fruits and vegetables. There is continued emergent evidence that cannabinoid medicine can act as a powerful prophylactic for migraine disorders.

Diagnosing Hemiplegic Migraines

Though hemiplegic migraines are rare, it’s important to ensure correct diagnosis. When choosing a treatment option, it’s crucial to consult a general physician to rule out other likely causes, considering hemiplegic migraines often can be confused with other complex neurological conditions like a stroke, transient ischemic attack, seizures, and other inherited disorders. In addition, a general physician will help you find a treatment plan catered to your medical history after diagnosing the condition correctly. For a migraine to be classified as a hemiplegic migraine, it must meet certain criteria. It should resemble a migraine with aura and have fully reversible motor weakness as well as fully reversible visual, sensory or speech/language symptoms. A neurologist can be sought for expert guidance in the case of rare and severe symptoms associated with hemiplegic migraine.