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’.
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?
- Numbness or weakness on one side of the body (Hemiplegia)
- Once side of the face can fall which looks like a stroke
- Visual disturbance and aura (sparkles, shimmers)
- Numbness or tingling in extremities
- Slurred speech or trouble speaking
- Confusion, brain fog and in extreme and very rare cases possible unconsciousness
- Ataxia – Muscles not working properly
- Nausea and/or vomiting
- Increased sensitivity to sound and/or light
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.
Treatment and Medication Options
Due to the nature or Hemiplegic Migraine, finding the right treatment can be difficult. 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.
Self Care and Lifestyle adaptations
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.
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.