In this post, we explore hemiplegic migraine, where migraine symptoms intertwine with temporary paralysis, resembling stroke-like effects. Joan’s firsthand experience highlights the sudden onset and diagnostic challenges encountered by those with this rare condition. Uncover the genetic foundations, distinguish between auras and seizures, and delve into essential insights for effective management. This comprehensive guide illuminates the profound impact of hemiplegic migraine, emphasizing the necessity of specialized care for accurate diagnosis and tailored treatment.
Joan’s Story
Joan was familiar with visual auras from childhood. At 27, she managed her migraine well with triptans and trigger avoidance. Last week, however, her aura was followed by tingling and then paralysis in her arm and leg. An ambulance took her to the ER, where she was treated for a stroke. The next day, her symptoms cleared, and she was told it might be hemiplegic migraine and that she should stop using triptans. She now has many questions but will have to wait to see a migraine specialist for a year.
Understanding Hemiplegic Migraine
What are auras?
Auras are neurological symptoms (vision, sensation, speech) caused by an abnormal electrical wave on the brain’s surface. The symptoms depend on where the wave travels. They also have a strong genetic basis. For more information, see our post on migraine with aura.
What is hemiplegic migraine?
Hemiplegic means “paralyzed on one side.” It describes migraine with an aura that includes weakness. Sometimes it’s hard to distinguish true motor weakness from “heaviness.” Testing movement and strength during an attack helps clarify.
Aura vs. Seizure
Both involve abnormal brain electrical activity but differ in speed and effects. Auras are slower and rarely show on EEG, whereas seizures often involve loss of consciousness and abnormal movements.
Genetics of Hemiplegic Migraine
Three genes (FHM1, FHM2, FHM3) are associated with hemiplegic migraine, affecting neuron function. Not everyone with hemiplegic migraine has these gene mutations. Both familial and sporadic cases exist, and future research may uncover more genes.
Why weakness with auras?
Gene mutations make neurons overly excitable, causing auras. When the electrical wave reaches the brain’s movement areas, it causes weakness.
Severe Hemiplegic Migraine Symptoms
Severe attacks can include fever, seizures, confusion, or coma, requiring ICU care. A thorough medical workup is essential for any neurological symptom.
Confusional Migraine
Not an official term, but some believe aura waves can affect brain areas managing language, memory, and focus, causing confusion.
Managing Hemiplegic Migraine
Evaluation by a neurologist or headache specialist is crucial. Use a headache diary to track symptoms and types of auras. Stroke after an aura is rare but possible; hemiplegic auras may last longer than typical auras.
Triptans and Hemiplegic Migraine
Triptans are usually not prescribed due to the risk of stroke from blood vessel constriction during severe auras. Discuss alternatives with a headache specialist.
Preventive Treatments
No specific studies for hemiplegic migraine exist, but magnesium, calcium channel blockers, topiramate, lamotrigine, acetazolamide, and Botox may help.
Conclusion
Hemiplegic migraine diagnosis and management require expertise. If you suspect you have this condition, seek evaluation from a headache specialist.
References
- Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol. 2011;10(5):457-70.
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