What is Hemiplegic Migraine?
Hemiplegic Migraine is a rare form of migraine where the person experiences many of the usual migraine symptoms, but may also suffer from temporary numbness, weakness or even paralysis on one side of their body!
The word Hemiplegia comes from the Greek – ‘Hemi’ meaning ‘half’ and ‘Plegia’ from either ‘plēgē’ meaning ‘stroke’ or ‘plēssein’ meaning ‘to strike’
The Medical Definition of Hemiplegic Migraine;
Hem·i·ple·gic mi·graine
‘A form of migraine associated with transient hemiplegia’
Now for the science part!
According to the Migraine Trust in the UK;
“The brain and nervous system depend on a combination of electrical and chemical signals to function. When a nerve impulse (electrical) of sufficient strength passes down from one nerve cell towards another, it opens a so-called ‘channel’ which acts like a ‘gate’. This process releases neurotransmitters (or chemical messengers) which contact the neighbouring cells and tell them how to respond. If a channel in the brain is not working properly, neurotransmitters, such as serotonin, may be released in an abnormal way. In the case of hemiplegic migraine, the way the channels dysfunction is known to have a role in the condition.”
Hemiplegic migraine is divided into two types, 1. Familial hemiplegic migraine (FHM) which means it runs in the family and 2. Sporadic hemiplegic migraine (SHM) which means it happens in one person. Both types often begin in childhood. So far, researchers have found three genes linked with FHM:
- CACNA1A
- ATP1A2
- SCN1A
Unlike a stroke, the symptoms of Hemiplegic Migraine begin slowly and build up as the migraine progresses. Weakness and numbness usually go away within 24 hours, but may last a few days.
Hemiplegic migraine can be one of the more difficult types of migraine to diagnose as many of the symptoms can mimic stroke, seizures or other conditions. MRIs, CT scans and other neurological tests, as well as a full review of your medical history are usually done to rule out other more sinister causes of the symptoms.
What are the Symptoms of Hemiplegic Migraine?
People, who suffer from Hemiplegic migraine specifically, experience a whole gamut including;
- Numbness or weakness on one side of the body (Hemiplegia)
- Once side of the face can fall which looks like a stroke
- Headache
- Visual disturbance and aura (sparkles, shimmers)
- Numbness or tingling in extremities
- Slurred speech or trouble speaking
- Fever
- Confusion, brain fog and in extreme and very rare cases possible unconsciousness
- Ataxia – Muscles not working properly
- Nausea and/or vomiting
- Dizziness/Vertigo
- Increased sensitivity to sound and/or light
What Triggers Hemiplegic Migraine?
Hemiplegic Migraine, like most other types of migraine can be triggered by many things, including food, weather, stress, lack of sleep, skipping meals, dehydration. The best way to figure out your triggers and when you might be in danger of an attack is to keep a diary, or even to use a migraine app like Migraine Buddy or Curelator. They will track your attacks and will hopefully help you to live as normal a life as possible while coping with this condition.
How do you treat Hemiplegic Migraine?
Medication:
Due to the nature or Hemiplegic Migraine, finding the right treatment can be difficult and many medications can be tried. Unlike other migraine types, Triptans are contraindicated for Hemiplegic Migraine as they constrict the blood vessels. This constriction may happen during the attack itself, thereby increasing the constriction and heightening the possibility of stroke so Triptans are rarely prescribed.
Acute medications used include the normal NSAIDs such as Ibuprofen or Diclofenac (Difene), along with an antiemetic (anti-nausea) medication such as Domperidone or Metoclopromide to ease the nausea, but also to aid in the faster absorption of other medication.
Hemiplegic migraine is generally treated with preventative medications, including;
- Calcium Channel Blockers – Verapamil (Isoptin), Flunarizine (Sibelium)
- Anticonvulsive Medication – Topiramate (Topamax)
- Antidepressants – Amitriptyline
Beta Blockers such as Propranolol (Inderal) are generally avoided as they can interrupt the dilation of the blood vessels, again heightening the chances of stroke.
Many people with Hemiplegic Migraine often find going to a specialist physiotherapist can help them, especially with exercises for movement during or after the attack on affected limbs. Physiotherapy can also help with pain management.
Lifestyle Modification:
Lifestyle can be an important factor in treating or coping with Hemiplegic Migraine. Making sure that you do the following can help immensely;
- Eat well, and never allow yourself to go hungry
- Keep hydrated
- Get into a routine at home of sleeping, eating and waking at the same time each day
- Try to keep stress at a minimum
- Do gentle, regular exercise
You could do worse than having a look at the website for the Mindfulness and Relaxation Centre of Beaumont Hospital they have exercises and relaxation tips that can help.
Other Possible Treatments:
Many people with migraine choose non-pharmaceutical methods of treatment and many of them can be used for Hemiplegic Migraine such as;
- Magnesium
- Coenzyme Q10
- Vitamin B2 (Riboflavin)
- Feverfew
Some other complementary treatments that sufferers find helpful include;
- Acupuncture
- Yoga
- Pilates
- Mindfulness
- Bio-Feedback
- Medical devices – eNeura Spring TMS, Cefaly device
Again, keeping a diary is useful and we can post you out one whenever you wish. Just drop us a line at info@migraine.ie or give us a call on 01 894 1280.
We also have a Migraine ID card which can be handy for people who lose the ability to communicate during an attack. It lets others know that it is a migraine attack and not a stroke, so you shouldn’t end up in A & E. It can also show the medications needed, and that the attack is temporary. It also has our Information and Support Line number on it. If you would like one, please contact us and we’ll be happy to send one out.
Hemiplegic Migraine is a very frightening form of migraine, especially when you experience or see if for the first time, but like all migraine, once you find the right treatment and help, you can learn to cope and live your life as normally as possible. It’s the finding the right treatment part that most have trouble with, but with most migraine, there’s always something else to try, so don’t give up hope. There are also new medications around to corner and they may give relief to a lot of people.
