Hemiplegic Migraine

Overview

Hemiplegic migraine is a rare type of migraine that causes temporary weakness on one side of the body. 'Hemiplegic' means one-sided weakness. It can also cause other migraine symptoms like visual changes, trouble speaking, confusion, and headache. The weakness usually goes away, but it can be frightening because it can look like a stroke. Always get new one-sided weakness checked by a doctor right away.

It is rare. It affects a small number of people with migraine.

It can affect children and adults. It often starts in childhood or young adulthood. People with a family history are more likely to have it.

Symptoms

Common symptoms

• Temporary weakness or numbness on one side of the body, such as the face, arm, or leg
• Visual changes like flashing lights, blind spots, or zigzag lines
• Trouble speaking or finding words
• Confusion or difficulty concentrating
• Headache that may be severe, or sometimes no headache at all
• Nausea or vomiting
• Sensitivity to light and sound
• Tingling or pins and needles, often starting in one hand and spreading

Symptoms in children

• Weakness on one side of the body that may switch sides in some children
• Confusion, drowsiness, or unusual behavior during an attack
• Vomiting and headache
• Attacks may be shorter or less typical than in adults

Symptoms in older adults

• New one-sided weakness must be checked urgently because stroke is more common with age
• Symptoms may be mistaken for a transient ischemic attack (TIA) or stroke
• Headache may be less prominent
• Talk to your doctor about any new migraine-like symptoms after age 50

Causes

Main causes

• Changes in genes that affect how brain cells send signals, especially in familial hemiplegic migraine
• A family history of hemiplegic migraine
• In sporadic cases, no clear family history is found

Risk factors

• Having a close family member with hemiplegic migraine
• Known migraine triggers such as stress, lack of sleep, skipping meals, dehydration, bright lights, or hormonal changes
• Being female (migraine is more common in women)
• Some foods or drinks may trigger attacks in some people, but this varies

When to see a doctor

See a doctor urgently if:

• Any first attack with one-sided weakness
• Sudden severe headache or the worst headache of your life
• New weakness, numbness, or trouble speaking
• An attack that is different from your usual migraines
• Symptoms that do not go away or get worse

Book a routine appointment if:

• You have migraines with unusual symptoms
• You want to discuss triggers or prevention
• Your migraines are affecting work, school, or daily life
• You have a family history of hemiplegic migraine

Diagnosis

Doctors diagnose hemiplegic migraine by talking with you about your symptoms, your medical history, and your family history. They also do a physical and neurological exam. Because the symptoms can look like a stroke, the first step is often to rule out stroke and other serious problems.

Tests that may be done

• Neurological exam to check strength, sensation, reflexes, and coordination
• Brain imaging such as MRI or CT scan to rule out stroke or other causes
• Blood tests to look for other conditions
• Lumbar puncture (spinal tap) in some cases, if infection or bleeding is suspected
• Genetic testing if there is a strong family history
• EEG (brain wave test) if seizures are suspected

What to expect at your appointment

You may need to go to an emergency department for your first attack so doctors can rule out a stroke. After that, your doctor may refer you to a neurologist (a brain and nerve specialist). Keeping a symptom diary can help your doctor understand your pattern.

Treatment

There is no cure for hemiplegic migraine, but treatment can help reduce attacks and relieve symptoms. Treatment has two main goals: treating attacks when they happen and preventing future attacks if they are frequent or severe. Always talk with your doctor before trying any medicine, because some usual migraine medicines may not be safe for people with hemiplegic migraine.

Self-care at home

• Rest in a quiet, dark room during an attack
• Drink water to stay hydrated
• Keep a symptom diary to spot triggers and patterns
• Get regular sleep and keep a consistent sleep schedule
• Eat regular meals and avoid skipping food
• Manage stress with relaxation, breathing exercises, or gentle activity
• Avoid known triggers when possible

Medical treatments

Doctors may prescribe medicines to relieve pain and nausea during an attack. If attacks are frequent or severe, they may suggest daily preventive medicines. Because hemiplegic migraine can raise the risk of stroke-like problems, some common migraine medicines are used with extra care or avoided. Your doctor will choose a plan that is safe for you. They may also recommend vitamins or minerals in some cases, but only under medical supervision.

When is surgery considered?

Surgery is not a treatment for hemiplegic migraine.

Living with this condition

Living with hemiplegic migraine means planning ahead and learning your early warning signs. Tell family, friends, and coworkers about your condition and what to do if an attack happens. Keep medicines with you, and have a plan for getting home safely if symptoms start.

Lifestyle tips

• Stick to a regular sleep schedule
• Stay hydrated
• Eat regular meals
• Manage stress
• Get gentle regular exercise
• Limit alcohol and caffeine if they trigger attacks
• Wear sunglasses in bright light if light triggers attacks

Diet and exercise

There is no special diet that cures hemiplegic migraine. Some people find that certain foods or drinks trigger attacks, but triggers are different for everyone. A balanced diet with regular meals can help. Gentle exercise like walking, swimming, or yoga may help reduce stress and improve sleep. Start slowly and avoid exercising in extreme heat or when you are dehydrated.

Mental health and emotional wellbeing

Hemiplegic migraine can cause fear and worry, especially because the symptoms can feel like a stroke. Anxiety and low mood are common with frequent migraine. Talk with your doctor if you feel anxious or depressed. If you ever feel you might harm yourself, contact your local emergency number or a crisis support line right away.

Prevention

You cannot always prevent hemiplegic migraine, but you can lower the chance of attacks by managing triggers, keeping a regular routine, and following your doctor's prevention plan. If attacks are frequent, preventive medicines may help.

Vaccines

There is no vaccine for hemiplegic migraine.

Screening programmes

There is no routine screening test for hemiplegic migraine. If you have a strong family history, talk with your doctor about genetic counseling and whether testing is right for you.

Complications

If left untreated

• More frequent and severe attacks
• Missed work, school, or social activities
• Anxiety and low mood
• Rarely, prolonged weakness or other serious neurological problems
• A small increased risk of stroke in some people, so blood pressure and vascular health should be checked

Long-term outlook

Most people with hemiplegic migraine can live full lives with the right care. Attacks often become less frequent over time, and treatment can help you manage symptoms. Work with your doctor to find a plan that keeps you safe and feeling well.

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