Understanding Hemiplegic Migraine

In simple terms, a hemiplegic migraine is a recurring migraine headache that is associated with reversible weakness on one side of the body. It is sometimes inherited and therefore may be titled Familial Hemiplegic Migraine. Typically the weakness is in the arm or leg, on one side of the body, which either preceeds the headache or is accompanied by the headache. The degree of the weakness may range from mild trouble with moving the extremity to a complete paralysis. It generally resolves within minutes to hours. Of note, this should not be confused with a general powerlessness someone might have when in severe pain.

Additionally, people who have weakness with their migraines may also experience other transient migraine symptoms called "auras", such as visual disturbances (spots, zigzags, loss of vision), changes in sensation (numbness, tingling) or speech problems. These symptoms typically last between 5 minutes and 24 hours.

The first time someone has a headache with numbness, weakness, visual changes or other neurological changes, it warrants an urgent evaluation. It can often resemble a stroke, at least
initially. Imaging and other testing are usually normal in hemiplegic migraines. Follow up with a
neurologist is greatly encouraged. Typically, people who have repeated events of headaches with weakness (and normal MRI) are diagnosed with hemiplegic migraines.

Treatment of hemiplegic migraines is similar to that of common migraines. In certain cases, however, triptans (such as sumatriptan, rizatriptan, etc) and ergotamine medications (such as DHE) are avoided due to contraindications.

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