Hemiplegic Migraines
A severe headache coupled with paralysis, but only on one side of the body.
Loss of balance.
A sense of vertigo.
“Oh my goodness. I am having a stroke," you think. “But I am so young. This can’t be happening!" You immediately alert your family to call 911. After a thorough workup, the physicians determine that you are not, in fact, having a stroke. Actually, after a period of time, your symptoms improve dramatically.
“We think you’ve had a hemiplegic migraine," they tell you.
“A migraine?" you think. “That sounds impossible."
What Is a Hemiplegic Migraine?
According to WebMD, a hemiplegic migraine is a rare type of a migraine but is serious because it mimics stroke symptoms. Symptoms are so extreme that at times, they can cause temporary paralysis of one side of the body, called hemiplegia.
The Daily Migraine notes that hemiplegic migraines are “a severe subtype of a migraine with aura. But in addition to classic auras, the person may experience muscle control and body sensations, speech and language disturbances and hearing issues."
The Two Types of Hemiplegic Migraines
This type of migraine can be subdivided into two types: familial and sporadic hemiplegic migraines.
Familial hemiplegic migraine (FHM) occurs in a least two members of the same family and these migraines must have weakness on one side of the body. Children of parents with hemiplegic migraines are much more likely to have FHM – 50% of children will go on to develop FHM.
Sporadic hemiplegic migraine (SHM) occurs as a result of “sporadic" gene mutation, hence the name sporadic hemiplegic migraine. People who suffer SHMs have no known genetic component to their hemiplegic migraines.
Hemiplegic migraines have been linked to issues with the following genes:
- CACNA1A
- ATP1A2
- SCN1A
When there is a mutation in these genes, the body is unable to make specific proteins. Nerve cells are then unable to process signals appropriately, which may cause the migraines.
Symptoms of Hemiplegic Migraines
Despite the fact that there are two identifiable types of hemiplegic migraines, the symptoms of the two are the same. Each person may have a combination of these symptoms, some of them at times, or all of them.
Some of these symptoms may start minutes to hours before an actual headache, hence why it is considered a migraine with “aura."
- A severe headache, which occurs on one side of the skull.
- A pins-and-needles sensation, typically traveling up and down the arm.
- Numbness on one side of the body, which can lead to temporary paralysis.
- A loss of balance and coordination, coupled with vertigo.
- Nausea and vomiting.
- Issues with speech, such as mixing up words or difficulty remembering words, and slurred speech.
- Double vision, or other visual disturbances.
Diagnosis of Hemiplegic Migraines
Diagnosis of hemiplegic migraines is often a diagnosis of exclusion – because people are complaining of extreme, stroke-like symptoms, imaging is performed to rule out a stroke. This is typically done by magnetic resonance imaging (MRI) or computed tomography scan (CT scan).
However, genetic testing can also be performed if there is a family history of hemiplegic migraines. Without a family history, you may get a diagnosis of SHM.
Treatment of Hemiplegic Migraines
Treatment of hemiplegic migraines is often debated; there is no clear-cut algorithm for treatment. However, traditional medicine, holistic migraine treatment, avoiding migraine triggers may help to reduce them.
Many doctors agree that if a trigger is identified, you should avoid that trigger in order to avoid a hemiplegic migraine.
According to the Diamond Headache Clinic, “Many of the abortive and pain relief drugs commonly prescribed for other migraine attacks, such as triptans and ergotamines, are contraindicated for a hemiplegic headache. Safe drug treatment options include NSAIDs, antiemetics (for nausea and vomiting) and narcotic analgesics."
That being said, WebMD notes that some MDs will prescribe triptans for the treatment of hemiplegic migraines. Both resources note that calcium channel blockers may be effective in treating hemiplegic migraines.