Hemiplegic Migraine
This is a rare form of migraine with two variations — familial hemiplegic migraine (FHM) and sporadic hemiplegic migraine (SHM).
Both often begin in childhood and cease during adult years. Getting a FHM or SHM diagnosis is difficult as the symptoms are also indicative of vascular disease and can be thought to be stroke, epilepsy or other conditions.
To rule out other causes and confirm a FHM or SHM diagnosis, a full neurological work-up and review of medical history (especially family medical history) and symptoms is necessary.
Both types of hemiplegic migraine share symptoms; the difference between the two is that FHM has been linked to specific gene mutations and can be traced back in the family history. Symptoms of FHM and SHM include:
- Episodes of prolonged aura (up to several days or weeks).
- Hemiplegia (paralysis on one side of the body).
- Fever.
- Meningismus (symptoms of meningitis without the actual illness or inflammation).
- Impaired consciousness ranging from confusion to profound coma.
- Headache, which may begin before the hemiplegia or be absent.
- Ataxia (defective muscle coordination).
- The onset of hemiplegia may be sudden and simulate a stroke.
- Nausea and/or vomiting.
- Phonophobia (increased sensitivity to sound) and/or photophobia (increased sensitivity to light).
Migraine With Aura
Migraine with aura occurs in about one-third of people with migraine, and aura may occur with only some and not all their headaches. In older people, it is common to have aura with no headache following.
Migraine with aura (MA) increases the risk of stroke, and women who have MA need to think carefully about the risks of certain treatments, including taking birth control pills that contain estrogen. Contrary to popular belief, aura is not just visual and can present in other ways:
- Scotoma, area of decreased or lost vision.
- Phosphenes, brief flashes of light that streak across the visual field.
- Blurry vision.
- Wavy lines.
- Aphasia, loss or impairment of the power to use or comprehend language, including both words and numbers.
- Allodyina, hypersensitivity to feel and touch (this symptom is what causes people to say that their hair hurts during a migraine).
- Dizziness.
- Confusion.
- Metamorphosia, a distortion of body image and perspective with a rare aura called Alice in Wonderland Syndrome.
- Other symptoms, including hiccups.
