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Hemiplegic Migraine

What is Hemiplegic Migraine?

Hemiplegic Migraine (HM) has an unusual and often alarming presentation that can mimic stroke, multiple sclerosis, epilepsy or metabolic disorders. Hemiplegia is a condition where one side of the body is weakened or paralysed. Technically, Hemiplegic migraine is a subcategory of Migraine with Aura. During a hemiplegic migraine attack, sufferers will experience weakness or paralysis of one side of the body, as well as more typical migraine aura symptoms such as visual, sensory, or speech disturbances1,2.

Types of Hemiplegic Migraine

1. Familial Hemiplegic Migraine

This subcategory of Hemiplegic Migraines refers to a sufferer that has one or more first- or second-degree relatives that suffer from the same condition1. There are several genes that have been identified that can contribute to this condition1,2.

2. Sporadic Hemiplegic Migraine

This subcategory of Hemiplegic Migraines refers to a sufferer that does not have any close relatives that suffer from the same condition1. In some cases, similar gene mutations have been found in sufferers of Sporadic Hemiplegic Migraine. This is referred to as “Sporadic Gene Mutation”, hence the name Sporadic Hemiplegic Migraine.

There are no significant differences in the prevalence of the two types of Hemiplegic Migraines. Hemiplegic Migraines often present with brainstem symptoms, in addition to the normal aura symptoms1,2. They are often mistaken for epileptic attacks and unsuccessfully treated as such.

Symptoms

Symptoms for Hemiplegic Migraine may include:

  • Severe headache, usually on one side of the head
  • Weakness or paralysis of one side of the body
  • Loss of muscle control
  • Inability to comprehend or formulate language
  • Numbness or tingling in the face and/or limbs
  • Dizziness
  • Drowsiness
  • Flashing lights in the vision, double vision or other visual disturbances

As a result of the alarming symptoms that are displayed in Hemiplegic Migraine, diagnosis must exclude all other possible conditions that present similarly. Some examples include severe migraine with aura, multiple sclerosis, metabolic disorders, conversion disorder, facial palsy, stroke or epilepsy. Another characteristic that can differentiate HM from classical migraine with aura is that minor head trauma can trigger HM.

What is the cause of Hemiplegic Migraine?

Hemiplegic migraines often have a genetic component. However, they are often triggered by head trauma1, whether it be mild or severe.

In those individuals that may be suffering from Hemiplegic Migraine and have no underlying pathology or disorder that can be recognised, another known cause may be due to a sensitised brainstem2.

A SENSITISED BRAINSTEM will perceive non-threatening stimuli and create pain to be felt where the sensory information was originally detected. This hyper-excitability of the pain sensation is due to the heightened arousal and sensitive brainstem. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.

I’ve already tried everything. What else can be done to help my Hemiplegic Migraine?

Over-the-counter painkillers, strong triptan medications, and even tricyclic antidepressants are some of the ways in which Hemiplegic Migraine sufferers have attempted to rid themselves or their child of the painful attacks. In some cases, these ways can alleviate the symptoms of Hemiplegic Migraine, however despite all of these treatment options, sufferers may still find themselves having painful attacks.

At the Brisbane Headache and Migraine Clinic™, we have seen countless Hemiplegic Migraine sufferers. So, if you suffer from Hemiplegic Migraine, or if you think it sounds like your symptoms, and medication has given you no significant relief, then we believe that you should have a thorough examination of your brainstem.

 

Imagine living a life free from headaches and migraines and saying goodbye to medications!

To gain your recovery today contact us on 1800 HEADACHE (toll free)

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  1. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. (2018). Cephalalgia38(1), 1-211. doi: 10.1177/0333102417738202
  2. Russell, M., & Ducros, A. (2011). Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. The Lancet Neurology10(5), 457-470. doi: 10.1016/s1474-4422(11)70048-5

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