Summary of hemiplegic migraine symptoms
Symptoms of a hemiplegic migraine include:
- Weakness in muscles on one side of your body.
- Vision changes such as blind spots, flashing lights, zig-zag patterns, and double vision.
- Numbness or tingling in your face, arms, and legs.
- Trouble speaking.
- Fatigue.
- Confusion.
These symptoms resemble those of a typical migraine during the aura phase, which happens just before or during the headache. However, hemiplegic migraines can affect muscles, speech, and vision differently from other migraine types. The symptoms may last from a few hours to several days, and in rare cases, up to four weeks. Usually, these symptoms disappear entirely.
What exactly is a hemiplegic migraine?
A hemiplegic migraine is a specific type of migraine characterized by symptoms and muscle weakness on one side of the body. Breaking down the term, hemi means half, and plegic means paralysis. This muscle weakness typically begins during the aura phase, either just before or during the headache, and may be accompanied by sensory disturbances, visual changes, or speech difficulties.
The main symptom of hemiplegic migraine is temporary weakness or paralysis on one side of the body. This weakness is a type of aura and is usually accompanied by at least one other aura symptom, such as visual disturbances, sensory changes, or speech and language difficulties.
These symptoms usually develop gradually over several minutes. While they often start to improve within a few hours, some individuals may experience symptoms that last for days or even weeks. A headache can occur alongside the aura or may begin roughly 60 minutes after the aura appears.
Hemiplegic migraine can impact just a part of the body, like the face, a hand, or an arm, but it may also cause weakness on one whole side. Additional symptoms may include balance and coordination issues, speech difficulties, fever, dizziness, impaired consciousness, and confusion.
These concerning symptoms can cause someone experiencing their initial hemiplegic migraine to believe they are having a stroke or a transient ischemic attack.
What are the causes of hemiplegic migraines?
Overactive nerve cells can trigger hemiplegic migraines. In particular, a nerve change known as cortical spreading depression leads to these migraines.
Nerve cells sustain an electrical charge that enables ions, charged particles, to pass through, aiding in the transmission of neurotransmitter signals throughout the body. Cortical spreading depression changes this charge via depolarization. It gradually spreads across the brain as a wave, disrupting the regular electrical activity of nerve cells. This disturbance leads to symptoms linked to a hemiplegic migraine. A genetic mutation impacts nerve cell function.
What are the triggers of hemiplegic migraines?
Hemiplegic migraine triggers are similar to those of other migraine types. They vary between individuals but may include:
- Stress
- Modifications to your sleeping schedule.
- Physical exertion.
- Head trauma.
- Bright lights.
- Certain foods or changes to your eating pattern (such as missing a meal).
Some hemiplegic migraines can occur after a specific imaging procedure known as a cerebral angiogram. This brain scan helps assess the functioning of your brain’s blood vessels.
What criteria are used to diagnose a hemiplegic migraine?
A doctor will diagnose a hemiplegic migraine through a physical and neurological exam. During these evaluations, your provider will inquire about your medical and family history. Be sure to inform them if you have relatives who experience migraines.
Tests help eliminate conditions with similar symptoms. Your doctor might recommend the following tests:
- A genetic test.
- A computed tomography (CT) scan.
- An MRI (magnetic resonance imaging).
- Lumbar puncture.
- Electroencephalogram.
What are the treatment options for a hemiplegic migraine?
A doctor might suggest or prescribe medications to treat hemiplegic migraine, such as:
- Antidepressants, including tricyclics and SNRIs.
- Anti-hypertensive medications such as beta-blockers or calcium channel blockers.
- Antiseizure medications.
- CGRP antagonists and/or botulinum toxin when suitable.
Discuss potential side effects of any prescribed medications with your doctor. They will inform you about the dosing schedule.
Is it possible to prevent hemiplegic migraines?
While it is not possible to prevent all hemiplegic migraines, your provider might suggest preventive medications to lessen their frequency. However, migraines can still occur despite these measures. Additionally, a provider can prescribe medications to halt a migraine once it begins, helping to decrease its duration and severity. They can also help identify triggers that may increase your risk, allowing you to manage your condition more effectively.
Check Your Symptoms
Living with hemiplegic migraine
When experiencing a hemiplegic migraine, you may feel anxious and scared. You might wonder, is this a stroke? Should I call 911? If you are unsure, do not hesitate to contact emergency services. Your care team will determine the cause of your symptoms and help manage your migraines, aiming to reduce their frequency. They will work with you to lessen the impact of hemiplegic migraines on your daily life.
Frequently Asked Questions
Is hemiplegic migraine considered an emergency?
A hemiplegic migraine can be concerning, but it is not an emergency. Its symptoms may mimic a stroke, which is a medical emergency, and can be confusing. Both conditions can lead to one-sided muscle weakness, visual disturbances, and speech difficulties. If you notice any symptoms similar to a stroke, call 911 or your local emergency number immediately. Remember, prompt medical attention is vital for a stroke. Avoid trying to determine whether it is a stroke or a hemiplegic migraine yourself. Seek emergency care right away.
How frequently does a hemiplegic migraine occur?
Hemiplegic migraines are rare compared to common migraines. A study in Denmark estimated that about 1 in 10,000 individuals experience hemiplegic migraines.
What is the sensation of a hemiplegic migraine?
A migraine headache causes intense, throbbing head pain. This headache often occurs alongside or after one-sided muscle weakness. You can identify a hemiplegic migraine when you lift both arms overhead; typically, one arm will feel heavier and more complicated to lift and hold up than the other.
When do hemiplegic migraines usually begin?
Most individuals experiencing hemiplegic migraines first encounter them during adolescence, typically between 12 and 17 years old. As age increases, both the frequency and severity of these migraines generally decline.
What is the typical duration of a hemiplegic migraine?
Hemiplegic migraine symptoms can last from one hour to several days, generally resolving within a day. On average, people experience around three attacks annually, though this varies. Some may have daily migraines, while others only rarely encounter them. There can be long periods without symptoms between attacks. Many report a decrease in migraine frequency with age, and after age 50, hemiplegic migraines often change into typical migraines without weakness. Consulting a doctor can help you find effective treatment options to manage migraines throughout your life.
