What is a Hemiplegic Migraine?

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  • Written By: J.M. Willhite
  • Edited By: Heather Bailey
  • Last Modified Date: 03 October 2019
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A hemiplegic migraine is considered a rare, genetic form of migraine disease. Those who suffer with hemiplegic migraines not only experience the traditional symptoms a migraine induces, but additional symptoms which may mimic those associated with a stroke. Treatment for this inherited condition is generally twofold, consisting of preventive medications prescribed over the long term and acute medications administered during severe episodes.

Considered to be a complex medical condition, the onset of a migraine headache is usually prefaced by warning signs. Individuals who suffer from migraine headaches may experience changes that affect hearing, sight, and speech. Those who experience symptoms associated with migraines with auras usually suffer more pronounced visual abnormalities. For individuals who have hemiplegic migraines, the signs and symptoms can be more debilitating, culminating in a general lack of coordination and control. During severe episodes, the individual may experience temporary paralysis on one side of his or her body.

Fortunately, though the symptoms associated with hemiplegic migraines may be quite intense, there is no risk of permanent neurological or physical damage. Symptom manifestation is dependent on the individual and may vary from episode to episode. Those who experience a hemiplegic migraine may exhibit symptoms that can include severe pain localized to one side of the head, impaired speech, and vertigo. Additional symptoms indicative of an episode may also include confusion, sensory sensitivity, and a lack of coordination. The manifestation of symptoms may be gradual and potentially last as little as an hour or several days.


Individuals experiencing symptoms which may be indicative of a hemiplegic migraine may undergo a variety of tests to confirm a diagnosis. Available since 2006, genetic testing is a relatively new option for determining if an individual possesses the genetic mutation associated with hemiplegic migraines. Those whose genetic testing confirms the existence of the mutation are diagnosed with familial hemiplegic migraine (FHM) disease. Individuals whose test results are negative are diagnosed with sporadic hemiplegic migraine (SHM) disease.

A comprehensive physical examination is generally conducted along with the analysis of a complete medical history. Since symptoms associated with this form of migraine may mimic those related to stroke, additional testing such as magnetic resonance imaging (MRI) or a computerized tomography (CT) scan may be conducted. Additional testing may include evaluations of the blood vessels, carotid artery, and heart to rule out any secondary conditions, such as a blood clot.

Prevention is the first step in treating hemiplegic migraines. It is imperative that individuals who receive a confirmed diagnosis educate themselves about the disease and the role of treatment in managing symptoms. An anticonvulsant, calcium blocker, or other supplements may be recommended to reduce episode recurrence and severity. Acute episodes may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs), narcotic selective central nervous system depressants, or analgesics, and anti-nausea medications to alleviate symptoms. Severe episodes may require the intravenous administration of magnesium sulfate, verapamil, or valproic acid (VPA).


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