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While hemiplegic migraine symptoms are typically temporary, they can sometimes cause lasting problems and even death
In rare cases, hemiplegic migraine can cause permanent brain damage, infarction, intellectual disability, and cardiovascular events that increase the risk of death.
What is a hemiplegic migraine?
Hemiplegic migraine is a rare, serious type of migraine that is characterized by:
- Severe headache on one side of the head
- Muscle weakness on one side of the body
- Numbness and tingling on one side of the body
- Visual disturbances (aura)
- Speech difficulties
- Decreased awareness
- Cerebellar ataxia
Symptoms may last from a few hours to several days, and in rare cases, up to a month. While symptoms are typically temporary, they can sometimes cause lasting problems.
What are the characteristic features of a hemiplegic migraine?
Characteristics of a hemiplegic migraine include the following:
- Unilateral muscle weakness (one-sided weakness) as an aura manifestation is a distinguishing hallmark of a hemiplegic migraine.
- Visual abnormalities, scotoma (blind spots), hemianopia (partial blindness), tingling, numbness, ataxia (difficulty with coordination), fever, or fatigue are all common aura symptoms.
- Motor symptoms often begin in the hand and progress to the arm and face. In rare cases, people may have bilateral motor weakness concurrently or sequentially.
- Symptoms normally appear over 20-30 minutes. However, aura symptoms and motor weakness can appear suddenly and mimic a stroke.
- Headache normally develops during the aura stage; however, it can also occur after aura symptoms. Encephalopathy or coma may accompany severe hemiplegic migraine episodes.
Severe symptoms, such as hemiplegia and reduced awareness, can linger for several days to months before resolving completely. Motor symptoms may continue longer than the headache in a hemiplegic migraine.
What are different types of hemiplegic migraines?
Hemiplegic migraine can run in the family or occur in people without a family history of the condition:
Familial hemiplegic migraine
Familial hemiplegic migraine runs in the family. This type of migraines is characterized by acute, throbbing pain in one side of the head, as well as nausea, vomiting, and increased sensitivity to light and sound.
These recurring headaches usually start in infancy or adolescence and may be triggered by certain foods, stress, or slight head trauma. Each headache may linger anywhere from a few hours to many days. Some individuals with a familial hemiplegic migraine may experience severe migraine symptoms such as fever, convulsions, chronic weakness, coma, and, in rare cases, death.
Although the majority of people with familial hemiplegic migraine recover entirely between episodes, neurological effects such as memory loss and problems with concentration can linger for weeks or months. About 20% of individuals with this condition experience moderate but chronic difficulty coordinating movements, which can worsen over time, as well as involuntary eye movements known as nystagmus.
Sporadic hemiplegic migraine
Sporadic hemiplegic migraine occurs in people who do not have a family history of the condition. These people may or may not have a migraine with aura in their family history.
What are treatment options for a hemiplegic migraine?
Because there are no conventional treatment protocols or standards for hemiplegic migraine, treatment options vary depending on the type and severity of symptoms.
Hemiplegic migraine episodes can be treated with analgesics and nonsteroidal anti-inflammatory medications. Verapamil, ketamine, and naloxone are used for the acute treatment of a hemiplegic migraine, but there is no evidence that acute therapy can reduce the intensity and duration of aura symptoms. Triptans and ergotamine are not recommended for treating hemiplegic migraine because they cause blood vessels to constrict, increasing the risk of stroke.
To reduce the frequency of attacks, people with hemiplegic migraine may try standard preventative drugs used to treat regular migraines, such as:
- Tricyclic antidepressants
- Beta blockers
- Calcium channel blockers
- Anti-seizure (anticonvulsant or anti-epileptic)
- Acetazolamide
- Verapamil
- Flunarizine
- Lamotrigine
