Athena Vale
Hemiplegic migraines are a rare form of migraine that can cause muscle weakness. They are characterised by episodic, reversible, unilateral motor weakness as a migraine aura manifestation, along with at least one other kind of aura. This weakness may be temporary and may affect all or just part of one side of the body. Hemiplegic migraines can be genetic, known as familial hemiplegic migraines, or occur sporadically in an individual, known as sporadic hemiplegic migraines. Accurate diagnosis is critical as the symptoms of hemiplegic migraines are similar to those of a stroke, seizures or other serious neurological conditions.
| Characteristics | Values |
|---|---|
| Type of migraine | Hemiplegic migraine |
| Frequency | Rare |
| Symptoms | Muscle weakness, temporary paralysis, headache, slurred speech, trouble with muscle control, severe throbbing pain, numbness, visual disturbances, communication difficulties, confusion |
| Severity | Mild to severe |
| Duration | 20 minutes to several days, rarely up to 4 weeks |
| Treatment | No standard treatment, treating migraine attack may help relieve weakness |
| Diagnosis | Challenging, episodic reversible unilateral motor weakness, along with other aura symptoms |
| Cause | Genetic, mutations in CACNA1A, ATP1A2, SCN1A, and PRRT2 genes |
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What You'll Learn
Hemiplegic migraine symptoms
Hemiplegic migraine is a rare and serious type of migraine with a range of symptoms that mimic those of a stroke. It can cause muscle weakness or even temporary paralysis on one side of the body, a condition that doctors refer to as hemiplegia. The muscle weakness may be accompanied by other common aura symptoms, such as:
- Visual disturbances: Changes in eyesight in both eyes, such as coloured spots, zig-zags or sparkles.
- Speech difficulties: Slurring words or being unable to speak clearly.
- Communication difficulties: Difficulty in writing and understanding language, which can cause problems with reading, listening, speaking and writing.
- A pins-and-needles feeling, often moving from the hand up the arm.
- Numbness on one side of the body, which can include the arm, leg, and half of the face.
The aura symptoms usually develop gradually over 20 to 30 minutes, but in rare cases, they can also develop suddenly. These symptoms typically last for a few hours to a day but can persist for several days or, rarely, up to four weeks. In most cases, the symptoms disappear completely. However, it is uncommon for some people to experience long-lasting difficulties with movement and coordination.
Hemiplegic migraines have various triggers, and it is not always possible to identify the cause of an attack. Common triggers include certain foods or smells, lights, stress, sleep irregularities, physical activity, and head trauma.
It is important to seek medical advice if you experience sudden muscle weakness or numbness on one side of your body. A doctor will be able to provide a clear diagnosis and rule out other serious neurological conditions, such as strokes or seizures.
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Motor weakness
Hemiplegic migraine is a rare form of migraine with aura, in which the migraine aura is characterised by motor weakness, usually on one side of the body. Hemiplegic migraine can be genetic (known as familial hemiplegic migraine) or sporadic. Some, but not all, gene mutations have been identified as causing familial hemiplegic migraine.
Hemiplegic migraine symptoms are often experienced on one side of the body and are stroke-like. In addition to motor weakness, symptoms during an attack can include confusion and speaking difficulties. This stroke-like aspect of hemiplegic migraine can be dangerous. Because these symptoms are similar to those for stroke, seizures and other potentially serious neurological conditions, there is a risk that what is thought to be a hemiplegic migraine attack is actually something more serious. Proper diagnosis of hemiplegic migraine is, therefore, critical for the right migraine management, care and treatment, and to rule out other causes.
Weakness can be mild to severe and may affect all or just part of one side of the body (e.g. hands, hand and arms or the face). Sometimes it can manifest as paralysis down one side of the body. Hemiplegic migraine attacks also involve at least one other visual, sensory, and speech or language aura symptom.
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Genetic factors
Migraines are a complex neurological disorder, the causes of which are not entirely understood. They are thought to be the result of a combination of genetic, environmental, and lifestyle factors, which lead to altered pain signals in the brain and inflammation of the blood vessels and membranes surrounding the brain.
One type of migraine, familial hemiplegic migraine (FHM), has a known monogenic cause. This rare, inherited form of migraine with aura has four subtypes, each based on a distinct genetic cause. The aura is always accompanied by weakness on one side of the body, and there may be drowsiness, confusion, and speech difficulties. FHM is an autosomal-dominant subtype of migraine with a diagnostic criterion that requires at least one first or second-degree relative to have had attacks fulfilling the diagnostic criteria for hemiplegic migraine. There are three identified gene mutations found in hemiplegic migraines: CACNA1A, ATP1A2, and SCN1A, which cause the related calcium channel in nerve cells to work incorrectly, resulting in a hemiplegic migraine attack. FHM1 is the most common type, accounting for around 50% of cases, and is associated with mutations in the CACNA1A gene on chromosome 19p13, which encodes the alpha-1A subunit of the P/Q-type calcium channel. FHM1 is commonly associated with cerebellar degeneration. Mutations in the ATP1A2 gene cause FHM2, accounting for less than 25% of cases. However, these specific mutations are not present in all families diagnosed with FHM, and the cause of sporadic hemiplegic migraine (SHM) is unknown but probably due to new or 'sporadic' gene mutations.
Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk. The more than 180 known variants belong to several complex networks of "pro-migraine" molecular abnormalities, which are mainly neuronal or vascular. For example, the intronic SNP rs9349379 near PHACTR1 is a proven risk locus for migraine, coronary artery disease, fibromuscular dysplasia, hypertension, and cervical artery dissection. A functional study showed that this SNP had no effect on PHACTR1 but on the gene encoding endothelin-1 (ET-1; EDN1), a strong vascular smooth muscle regulator. Recent studies comparing chronic and episodic migraines have also found genetic variants in the TRPM8 gene, the TRPV1 gene, and HLA class I alleles to be associated with chronic migraine.
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Diagnosis and treatment
Hemiplegic migraine is a rare form of migraine with aura, characterised by motor weakness, usually on one side of the body. The aura symptoms of a hemiplegic migraine can include visual disturbances, speech difficulties, and communication difficulties. The weakness may last from one hour to several days, but usually goes away within 24 hours.
Diagnosis of hemiplegic migraine is primarily clinical and can be challenging. The characteristic feature for diagnosis is an episodic, reversible, unilateral motor weakness as a migraine aura manifestation, along with at least one other kind of aura. It is essential to rule out other common pathologies that could potentially cause a headache and neurological deficits. A good history of symptoms, potential triggers, family history, and other associated symptoms is essential for diagnosis. The diagnostic criteria for familial hemiplegic migraine require that at least one first or second-degree relative has had attacks fulfilling the diagnostic criteria for hemiplegic migraine.
There is no standard treatment for hemiplegic migraine. However, there are a number of ways to manage and reduce symptoms, including medications, exercise, and developing a wellness routine. Treating the migraine attack itself generally helps to relieve weakness or numbness. Certain drugs used to treat general migraines, like triptans, are not recommended for hemiplegic migraine. Drugs that may work for hemiplegic migraine include acetaminophen, dihydroergotamine, and magnesium sulfate. It is important to talk to a doctor about different medicines, their side effects, and the symptoms experienced to develop a treatment plan that best addresses individual needs.
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Muscle weakness and migraine aura
Hemiplegic migraine is a rare form of migraine with aura that can cause muscle weakness. It is a distinct condition in which motor weakness occurs, usually on one side of the body. This weakness may be temporary and mild or may result in severe and long-lasting paralysis. In addition to muscle weakness, hemiplegic migraine symptoms during an attack can include confusion, speaking difficulties, visual disturbances, and more.
Hemiplegic migraine is characterised by a specific type of aura that people with this condition experience. Migraine aura refers to a collection of fully reversible neurological symptoms that many people with migraine experience before or during an attack. In typical migraine with aura, the aura can affect one or more of a person's visual, sensory, or language and speech functions. The most common aura is visual (e.g. blind spots, pixelated vision, flashing lights). However, hemiplegic migraine is a migraine with aura that also affects the person's motor function.
The symptoms of hemiplegic migraine can be similar to those of a stroke, including slurred speech, trouble maintaining control of arms and hands, and sudden weakness or numbness on one side of the body. This similarity can be dangerous as it can mask other serious medical issues. Accurate diagnosis of hemiplegic migraine is critical to ensure the correct management, care, and treatment, and to rule out other causes.
The cause of hemiplegic migraine is currently unknown, but it may be genetic. It is believed to be associated with mutations in the CACNA1A, ATP1A2, SCN1A, and PRRT2 genes, which create errors in how nerve cells in the brain work and may cause the migraine and associated weakness. Certain nerve cells also become overactive during hemiplegic migraine, which may contribute to the symptoms of migraine, including weakness.
There is no standard treatment for hemiplegic migraine or the associated weakness. However, treating the migraine attack itself generally helps to relieve weakness or numbness. It is important to talk to a doctor about different treatment options, as certain drugs used to treat general migraines may not be recommended for hemiplegic migraine.
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Frequently asked questions
Hemiplegic migraine is a rare form of migraine that can be serious and sometimes causes stroke-like symptoms. It is often genetic and tends to run in families.
The symptoms of a hemiplegic migraine include temporary muscle weakness or even paralysis on one side of the body. Other symptoms include visual disturbances, speech difficulties, and a pins-and-needles feeling.
The symptoms of a hemiplegic migraine usually last for 20 to 60 minutes but can last for several days and, in rare cases, up to 4 weeks. The muscle weakness typically goes away within 24 hours.
There is no standard treatment for hemiplegic migraines. However, there are ways to manage and reduce symptoms, including medication, exercise, and developing a wellness routine.
