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.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

Comments

View Comments (8)
  • Eddie
    4 years ago

    One week ago I seem to have suffered my first HM. I was beginning a volunteer study, so I happened to be with a nurse. She thought I was having an emotional reaction to the I.V cath she had just placed. Actually I was stressed but I don’t think I need to mention the details here. Just seconds after she flushed saline in the cath, I had tingling on my R side from top of head to waistline, then briefly in leg, then it took extra effort to lift forearm, then my aura, followed by confusion/mixed thoughts/very difficult to vocalize thoughts. But when my speech became slurred, she and the other person in the room decided it looked like a stroke and called 911. Of course paramedics said no stroke/no blood sugar problem. I had MRI at ER and it was normal. My diagnosis was Altered state: confusion. But 3 days later the study nurse (not related with ER hosp) sent me a link for HM. Now I am thinking I should go to my Dr, but expecting he won’t know anything about HM.
    I have had silent migraines that have become associated with mild headache since I was 30. Lately these only occur a couple times a year. Just the day/night before this I had Red wine, cheese, and also have been eating ‘a lot’ of dark chocolate. Now I am 50 (male), so I am very old to have 1st HM?
    How important is it that I see a Dr anytime soon? I also was diagnosed one year a go with borderline glaucoma, so am a bit concerned about my overall neuronal health.
    THANK YOU ALL for being here.

  • Jackie DeCesaris
    5 years ago

    Yes, I agree with Glenda. I have HM and mine can go on, unstopped, back to back for days, weeks, months at a time, all the while getting intensive medical treatment at University hospitals in the DC area. However, I have a severe form, but any HM episode(s) can get more crazy than you describe. Also…the weakness/paralysis IS parts of the aura, and in fact is atypical aura as part of cortical spreading during the migraine phase, or complex aura. I would also like to add that patients can experience temporary, yet possibly sustained mental confusion, and/or decreased mental awareness before, especially during, and even after the episode. Postdrome HM can last days, weeks and blend into the next, newer HM, adding to the distress and confusion for patients and diagnosing physicians not familiar with HM who may mistakenly go on limited descriptions of the disease.

    I only mention these things because when I was first dealing with HM many articles left these things out and left me thinking I was possibly misdiagnosed with HM since I had these seemingly additional issues which are actually quite common for HM. For newcomers, they may not have things as rough as I do, but at the same time I would like them to not be alarmed if they DO happen. If you have HM, things get more complicated than you’ve described, and it could me misleading. Thanks!

  • Glory
    5 years ago

    I recall vividly the first time this particular nightmare visited me about 35 years ago. I was sure I was having a stroke, but my now very much ex husband of that time refused to take me to the hospital. I attempted to call 911, but found I was incapable of speech. So, I sat on the sofa and waited to die. (911 At that time was not capable of dealing with nonvocal camera in our tiny town).

    My symptoms were a complete paralysis of my right side, inability to speak clearly, and a definite deterioration of my mental faculties. The only reason it was eventually connected to my classic migraine was due to the aura that was present.

    I am fortunate. During my lifetime, I have only suffered somewhere around 20 of these monsters in 58 years. There is no family history. I’m just the odd one out.

    I cannot imagine what suffering someone must go through where this is their typical migraine pattern. Everything it his me, I really am sure I will die. Typically, my symptoms last between 24-48 hours after an attack, then slowly resolve until I am more or less functional again.

    Fortunately, neither of my sons appease to have inherited this particular nastiness, for which I am thankful.

  • Dr. Larisa Syrow author
    5 years ago

    Glory, thanks for posting that vivid description of what it’s like for you to have a hemiplegic migraine. The first episode that you mentioned “waiting to die” is quite a powerful statement about how you felt. It helps for other readers to know that they are not alone in their experience.

    If you had found something specifically helpful in dealing with the attacks, please share that, as well.

  • Valerie
    5 years ago

    Many doctors and even neurologists know little to nothing about Hemiplegic Migrains. My neurologist asked me about my symptoms and when i told him that my paralysis comes and goes as it sees fit (it can last for as little as an hour up to my record so far…48 hours) he simply told me that what i was describing was impossible. Oftentimes i’m the one explaining things to the neurologist and i’v actually stopped going alltogether. It would wonderfull to have more open minded doctors who go out and listen to people and revise these ‘boxes’ that we have all been put in. I worry about my paralysis and congnative functions lasting more that 48 hours and never going away…it has been getting progressivly worse as iv been getting older and im only in my twentys….but its hard to find information about preventing that from happening when your neurologist says its simply not possible. In other words, id love to hear more about this particular topic from both of you 😀

  • Dr. Larisa Syrow author
    5 years ago

    Valerie, I’m sorry to heart about your disappointing experience. I imagine it must be very painful that your own symptoms were not validated, let alone not addressed. Lets give it the benefit of the doubt and say it was a misunderstanding.

    Going forward, I highly encourage you to try again to find someone who will be a partner with you in finding ways to decrease your suffering with hemiplegic migraines. The key is to always keep hope that relief is around the courner. There are many new treatments used for migraines lately (hemiplegic and not) so please dont give up.

    It’s true there isn’t as much written about hemiplegic migraines in text books, so perhaps it may be appropriate for you to seek a neurologist who is a headache specialist, who might understand you better.

  • Glenda
    5 years ago

    My name is Glenda Eakle. I work at a support group…LWHM. I have to respectfully disagree with your definition of Hemiplegic Migraines. The aura and hemiplegia do not always go away within minutes or hours. We have many members that suffer chronically. We also have some that have permanent problems with paralysis, memory, cognitive function, etc. The woman that pointed this article out to me is in a wheelchair because of some permanent paralysis. Our community has a very hard time in getting funding and reasearch for HM due to definitions like this. I welcome you to come and visit us so you can understand what it is like to deal with chronic HM.

  • Dr. Larisa Syrow author
    5 years ago

    Dear Ms. Eakle. Thank you for sharing your thoughts regarding this topic; I see your point.

    I had put that time duration for the hemiplegic migraine because that’s the standard classification, but you’re right in that the individual situation may be very different. Some people, as you’ve said, have much longer duration of symptoms.

    Certainly in cases where the weakness is either permanent or very prolonged, and where it’s accompanied by other symptoms (such as the memory changes and cognitive functions) the diagnoses should be based on a close, long-term follow up with a trusted physician.

    I welcome any other thoughts you may have on the topic.

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