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Have you ever had a migraine headache that involves weakness or paralysis on one side of your body? If so, you may have had a hemiplegic migraine attack.
Hemiplegic migraine attacks are significantly rarer than standard migraine headaches. Having a hemiplegic migraine attack can be a confusing and concerning experience because they can feel and look like a stroke.
Feeling weakness on one side of the body is the key symptom of a hemiplegic migraine attack. It usually starts in the aura phase of the migraine, and symptoms may vary, including mild clumsiness or paralysis.
With a hemiplegic migraine attack, when you raise both arms in front of you, one will feel heavier and harder to hold up than the other.
In addition to one-sided muscle weakness, at least one other aura symptom from the following symptoms of hemiplegic migraine should be present:
These symptoms usually last a few hours to a few days. In rare cases, they may even last for weeks. Most of the time, symptoms will go away, although they can significantly disrupt your life.
In rare cases, severe complications can occur, including seizures, memory loss, developmental challenges (in children), and coma.
Some people with migraine experience temporary neurological symptoms called an aura. Aura symptoms may serve as a warning sign for a migraine headache or happen at the same time as the head pain.
In hemiplegic migraine, aura symptoms tend to last longer — and muscle weakness always comes with another aura symptom. For example, someone might describe tingling starting in one hand that then travels up the arm and to the face, paired with paralysis on that side.
Sensory changes like numbness or tingling, as well as aphasia (difficulty speaking, reading, writing, or understanding words), are common with this type of migraine. Visual aura symptoms, on the other hand, are less common.
The first attack of hemiplegic migraine can be very alarming because the symptoms have a lot of overlap with those of a stroke.
A stroke is a severe emergency and requires immediate medical attention. If you think you or a loved one may be having a stroke, seek emergency care right away.
Symptoms that hemiplegic migraine and stroke have in common include:
However, there are some differences. The head pain associated with hemiplegic migraine may come on more slowly than the head pain caused by some kinds of stroke. Also, vomiting usually begins after a migraine headache. In a stroke, vomiting and headaches often happen at the same time.
It’s important to seek medical attention to receive a diagnosis, as specific tests may be required.
Unlike with a migraine attack, in a ministroke — also called a transient ischemic attack or TIA) — some key stroke symptoms may happen and then clear up within a few minutes. This situation still requires medical assistance right away, even if the symptoms go away quickly.
Researchers believe that hemiplegic migraine may be caused by overactive nerve cells, through a mechanism called cortical spreading depression.
In cortical spreading depression, the normal pattern of electrical charge in your nerves is disrupted, moving like a wave from one side of your brain to the other. This is what causes the symptoms of a hemiplegic migraine attack.
Certain genetic mutations (variations) are associated with hemiplegic migraine, so if a family member has the condition, you may be more likely to have it as well. However, not everyone who has hemiplegic migraine has a family history of migraine.
A hemiplegic migraine attack, like other types of migraine attacks, can be triggered by how you’re feeling and your environment.
Possible triggers include:
Hemiplegic migraine usually starts between the ages of 12 and 17, and tend to decrease with age. Most people report that after age 50, hemiplegic migraine ends, and is often replaced by traditional migraine without one-sided muscle weakness.
If your doctor suspects hemiplegic migraine, they will likely diagnose it after a physical exam and a neurological exam.
They may also order tests, primarily to rule out other conditions. Possible tests include an MRI, a CT scan, a genetic test, a lumbar puncture, and an electroencephalogram.
Once a diagnosis is made, your doctor may recommend medication to reduce the frequency or severity of hemiplegic migraine attacks. Treatment may vary if you have an identified genetic mutation.
Migraine medications that may be used for treating hemiplegic migraine include:
They will also inform you about how to react to attacks and when to seek medical attention, which may depend on your specific case.
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
Do you have hemiplegic migraine? Let others know in the comments below.
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