Hemiplegic Migraine: What It Is, Symptoms & Treatment

Overview

What is a Hemiplegic Migraine?

• A rare type of migraine causing one-sided muscle weakness.
• Symptoms can mimic a stroke, requiring emergency service contact in case of stroke-like symptoms.
• Diagnosed and treated by healthcare professionals.

Types of Hemiplegic Migraines

• Familial Hemiplegic Migraine: Genetically linked, with three specific subtypes based on different genetic changes.
• Sporadic Hemiplegic Migraine: Occurs randomly without family history.

Emergency Concerns

• Not a medical emergency but has similar symptoms to a stroke.
• Urgent care needed to differentiate between stroke and migraine symptoms.

Prevalence

• Rare, affecting approximately 1 in 10,000 people (study from Denmark).

Symptoms and Causes

Symptoms

• Muscle weakness on one side.
• Vision changes: blind spots, flashing lights, zig-zag patterns, double vision.
• Numbness or tingling in face, arms, legs.
• Speech difficulties, fatigue, confusion.
• Symptoms last hours to days, rarely up to four weeks.

Causes

• Overactive nerve cells with cortical spreading depression leading to symptoms.
• Genetic mutations can impact nerve cell function:
  • CACNA1A, ATP1A2, SCN1A, PRRT2 genes.
• Triggers include stress, sleep changes, physical exertion, head trauma, bright lights, certain foods.

Onset and Complications

• Typically starts during adolescence (ages 12-17).
• Symptoms generally resolve in days; rare complications include seizures, memory loss, personality changes.

Diagnosis and Tests

Diagnostic Process

• Physical and neurological exams, family history.
• Tests to rule out similar conditions:
  • Genetic testing, CT scan, MRI, lumbar puncture, electroencephalogram.

Management and Treatment

Treatment Options

• Medications: Antidepressants, anti-hypertensives, antiseizure drugs, CGRP antagonists, botulinum toxin.
• Consult healthcare provider regarding side effects and dosage schedules.

Prevention

Preventive Measures

• Some medications can reduce frequency but not eliminate migraines.
• Identifying triggers with provider assistance.

Outlook / Prognosis

What to Expect

• Symptoms persist for hours to days, typically subsiding after a day.
• Frequency and severity tend to decrease with age, especially post-50.

Consultation Advice

• Seek help for muscle strength-affecting symptoms.
• Emergency services for potential stroke symptoms.

Questions for Healthcare Providers

• Treatment recommendations and side effects.
• Preventive medication schedules.
• Safety of NSAIDs for treating migraines.

Conclusion

• Hemiplegic migraines, though alarming, are manageable with medical support.
• Importance of professional diagnosis to distinguish from strokes.
• Cleveland Clinic offers specialized neurology care tailored to patient needs.