Do you sometimes experience a severe headache accompanied by numbness or weakness on one side of your body? Do you sometimes have difficulty speaking? This is not just any migraine. This is a special type of migraine that is very important to be aware of. Today we are talking about a condition called Hemiplegic Migraine.
What is Hemiplegic Migraine?
Simply put, a hemiplegic migraine is a condition in which a migraine causes muscle weakness on one side of your body . This muscle weakness usually begins during the "aura" phase of a migraine. That is, it occurs either before or after the headache begins. This muscle weakness can sometimes be accompanied by changes in vision, difficulty speaking, and changes in sensation.
Imagine, you suddenly can't lift one arm, or you have difficulty moving one leg, or you feel like your mouth is going to one side. When something like this happens, everyone gets scared, right? That's what happens in this case.
What types of hemiplegic migraine are there?
There are two main types of hemiplegic migraine, which are divided into two types based on the underlying cause:
1. Familial Hemiplegic Migraine (FHM): This type occurs if someone in your family has had it before, meaning there is a genetic link . There are several subtypes of this type (FHM type 1, type 2, type 3). Each of these subtypes is caused by a different gene mutation. Sometimes, if doctors cannot find the specific gene mutation, it is also called FHM type 4.
2. Sporadic Hemiplegic Migraine (SHM): This type can occur suddenly in a person without any family history of the condition. That is, it occurs without a family history of the disease.
Is hemiplegic migraine an emergency?
This is something that many people are afraid of. While experiencing a hemiplegic migraine can be scary, it is usually not an emergency . However, the problem is that its symptoms are very similar to those of a stroke, which requires emergency medical treatment. Muscle weakness on one side of the body, changes in vision, and difficulty speaking can be seen in both.
Very important: If you ever experience any of these symptoms, especially numbness on one side of your body, loss of consciousness, or difficulty speaking, do not try to decide for yourself whether it is a stroke or a hemiplegic migraine. Please go to the nearest hospital or call an emergency ambulance immediately. In the case of a stroke, time is of the essence. Therefore, if in doubt, it is wise to seek medical advice.
How common is this condition?
While migraines are a common condition, hemiplegic migraines are not as common . A study in Denmark found that the condition affects only one in 10,000 people.
What are the symptoms of hemiplegic migraine?
The symptoms that appear in this condition are:
- Muscle weakness on one side of the body: This is the main symptom. An arm, leg, or one side of the face may be weak.
- Vision changes: Blind spots, flashing lights, zig-zag patterns, and double vision may occur.
- Numbness or tingling sensation in the face, hands, or legs .
- Difficulty speaking: Slurring words, unable to speak clearly.
- Feeling very tired (Fatigue).
- Feeling confused.
These symptoms are similar to those typically seen during the "aura" phase of a migraine (that is, before or during the headache). However, hemiplegic migraines can affect muscles, speech, and vision differently than other types of migraines.
These symptoms can last from a few hours to a few days. In rare cases, they can last up to four weeks. However, in most cases, these symptoms disappear completely .
How does a hemiplegic migraine feel?
A migraine causes a severe, throbbing headache . This headache usually comes after or with muscle weakness on one side of the body. A simple way to tell if you have a hemiplegic migraine is to raise both arms above your head. One arm may feel heavier than the other, making it harder to hold .
What causes hemiplegic migraine?
The main cause of this has been identified as excessive activity in nerve cells . Specifically, this is caused by a change in your nerves called "Cortical Spreading Depression".
Simply put, an electrical charge travels through our nerve cells. This helps ions (ion molecules) travel through the nerve cells, send messages to neurotransmitters, and communicate with different parts of the body. This electrical charge changes (depolarization) in a process called "cortical spreading depression." Like a slow wave, it travels from one side of the brain to the other, disrupting the normal electrical pattern of the nerve cells . That's what causes the symptoms of a hemiplegic migraine.
This is caused by a genetic mutation . That is, changes in genes that affect the way nerve cells function. The following gene variants have been identified in people with hemiplegic migraine:
- `CACNA1A` (familial type 1 or autosomal recessive type)
- `ATP1A2` (type 2 that comes from a family background or the spontaneous type)
- `SCN1A` (3 types coming from family background)
- `PRRT2` (all types from family backgrounds)
Doctors currently suspect that there may be other, yet unidentified, subtypes.
What are the triggers for hemiplegic migraine?
The things that make hemiplegic migraines worse, or ``Triggers'', are the same as other types of migraines. These can vary from person to person, but some common ones include:
- Stress
- Changes in sleep patterns (not sleeping well, sleeping too much)
- Physical exertion
- Head Trauma
- Bright light
- Certain foods or changes in eating habits (for example, skipping meals)
Some hemiplegic migraines begin after a special imaging test called a cerebral angiogram. This is a scan that looks at how the blood vessels in the brain are functioning.
When does hemiplegic migraine usually start?
Most people first experience hemiplegic migraines when they are young, between the ages of 12 and 17. As you get older, the frequency and severity of these migraine attacks usually decrease.
What are the possible complications of hemiplegic migraine?
Most hemiplegic migraine attacks resolve within a few days. However, in rare and severe cases , hemiplegic migraine symptoms can last for weeks. A migraine can affect your mental and physical health. Symptoms can interfere with your personal activities, social relationships, and work or schoolwork.
Serious complications are rare, but they can occur. Examples:
- Seizures
- Memory Loss
- Changes in personality or behavior
- Cognitive Development Problems (Intellectual Disability)
- Difficulties in the development of speech and motor skills in young children
- Coma
How is hemiplegic migraine diagnosed?
A doctor diagnoses hemiplegic migraine after a physical exam and a neurological exam . During these exams, the doctor will ask you about your medical history and your family's medical history. Be sure to tell your doctor if any of your blood relatives have migraines.
It is important to get tested to rule out other conditions that have similar symptoms. Your doctor may recommend tests such as:
- Genetic Test
- CT Scan
- MRI scan `(MRI)`
- Lumbar Puncture
- An electroencephalogram (EEG)
How are hemiplegic migraines treated?
A doctor may prescribe medications like these for hemiplegic migraine:
- Antidepressants (e.g., tricyclics and SNRIs)
- Anti-hypertensives (e.g. beta-blockers or calcium channel blockers)
- Antiseizure Medicines
- If necessary, CGRP Antagonists and/or Botulinum Toxin
Talk to your doctor about the side effects of any medication you are given. He or she will also tell you how often and how to take each dose.
What can I expect if I have hemiplegic migraine?
When you start having symptoms of hemiplegic migraine, it's normal to feel anxious and scared. You may even think it's a stroke, especially if you've never had one before. The pain and weakness you feel can make it difficult to do your daily activities.
The good news is that the symptoms of hemiplegic migraines usually go away once the migraine cycle ends, and there are treatments that can help reduce the frequency of these migraines.
How long does a hemiplegic migraine last?
Hemiplegic migraine symptoms can last from an hour to several days . However, these symptoms usually disappear within a day. On average, people can have about three hemiplegic migraine attacks per year. This number varies from person to person.
The number of migraine attacks you have can also vary. You may have one a day, or just a few in your lifetime. Sometimes there may be long, symptom-free periods between migraine attacks.
Many people say that migraine symptoms decrease as they age . Typically, after age 50, hemiplegic migraine can become a regular migraine without muscle weakness. A doctor can help you find treatments to manage your migraines throughout your life.
Can hemiplegic migraine be prevented?
It is not possible to prevent all hemiplegic migraine attacks. However, your doctor may recommend preventive medications to reduce the frequency of migraine attacks. However, remember that migraines can still occur even with these medications. Also, once a migraine has started, your doctor may prescribe medications to stop it, reduce its duration, and reduce its severity.
Your doctor can also help you identify your migraine triggers, so you can reduce your risk.
When should I see a doctor?
If you have migraines with symptoms that affect muscle strength, see a doctor.
Extremely important: If you experience symptoms of a stroke – such as weakness on one side of the body, confusion, or trouble speaking – call 911 (or your local emergency number) immediately.
If you are not sure whether you are having a hemiplegic migraine or a stroke, call emergency services . If you are unsure, or if there is no official diagnosis, it is safest to stay under the care of a doctor.
What questions should I ask my doctor?
- What kind of treatment do you recommend?
- What are the side effects of the treatment?
- When and how often should I take preventive medications?
- Is it safe for me to take an NSAID to treat a hemiplegic migraine?
Finally, things to remember
When you experience a condition called hemiplegic migraine, you may feel scared and anxious. You may wonder, "Is this a stroke? Should I call 911?" Don't hesitate to call emergency services if you're not sure. Your medical team can help you identify the cause of your symptoms, manage your migraines, and prevent them from happening again. Your doctor will work with you to help reduce the impact hemiplegic migraine has on your life. Don't worry, this condition can be managed.
` Hemiplegic migraine, migraine, headache, muscle weakness, stroke, symptoms, treatment
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