Hemiplegic migraine is referred to as a “migraine variant”. The word hemiplegic simply means paralysis on one side of the body. A person with hemiplegic migraine will experience a temporary weakness on one side of their body as part of their migraine attack.
Hemiplegic migraine is a rare and a serious type of migraine headache.
The temporary weakness can involve the face, arm or leg and be accompanied by numbness, or pins and needles. The person may experience speech difficulties, vision problems or confusion. This can be a frightening experience for the individual as these symptoms are similar to those of a stroke.
The weakness may last from one hour to several days, but usually it goes within 24 hours. The head pain associated with migraine typically follows the weakness, but the headache may precede it or be absent.
What causes hemiplegic migraine?
Hemiplegic migraine is divided into familial hemiplegic migraine (runs in the family) or sporadic hemiplegic migraine (happens only in one individual).
This is a very rare migraine type so if you ever experience new or never-evaluated weakness with your headache, you should seek immediate medical evaluation.
Though the causes aren’t understood, genetics and environmental factors appear to play a role.
Migraines may be caused by changes in the brainstem and its interactions with the trigeminal nerve, a major pain pathway.
Imbalances in brain chemicals — including serotonin, which helps regulate pain in your nervous system — also may be involved.
Serotonin levels drop during migraine attacks. This may cause your trigeminal nerve to release substances called neuropeptides, which travel to your brain’s outer covering (meninges). The result is migraine pain. Other neurotransmitters play a role in the pain of migraine, including calcitonin gene-related peptide (CGRP).
Symptoms of hemiplegic migraine
Symptoms of hemiplegic migraine can be more severe and will last longer than with other types of migraine. These stroke-like symptoms can range from worrisome to disabling. Unlike a stroke, the symptoms typically come on slowly until they build and then completely go away.
The following are the symptoms of hemiplegic migraine:
- Motor weakness on one side of the body (Hemiplegia)
- Other typical aura symptoms – vision changes (sparkles, shimmers, visual field defects), numbness, tingling, trouble speaking
- Impaired consciousness ranging from confusion to profound coma
- Ataxia (defective muscle coordination)
- Nausea and/or vomiting
- Phonophobia (increased sensitivity to sound) and/or photophobia (increased sensitivity to light)
The symptoms of hemiplegic migraine can be dramatic and frightening. Individuals with hemiplegic migraine often see many healthcare providers in their quest to understand their condition.
Foods you should avoid to prevent hemiplegic migraine
Certain foods, stress, or a minor head trauma may also be a trigger when it comes to hemiplegic migraine. As many as 12-60 percent of those who have migraines report certain foods are triggers.
Foods that often cause a problem include:
- Peanuts, peanut butter, almonds, and other nuts and seeds
- Pizza or other tomato-based products
- Potato chip products
- Chicken livers and other organ meat
- Smoked or dried fish
- Pickled foods (pickles, olives, sauerkraut)
- Sourdough bread, fresh baked yeast goods (donuts, cakes, homemade breads, and rolls)
- Brewer’s yeast found in natural supplements
- Bread, crackers, and desserts containing cheese
- Most beans including lima, Italian, pole, broad, fava, navy, pinto, snow peas, garbanzo, lentils, and dried beans and peas
- Certain fresh fruits, including ripe bananas, citrus fruits, papaya, red plums, raspberries, kiwi, and pineapple
- Dried fruits (figs, raisins, dates)
- Soups made from meat extracts or bouillon (not homemade broth)
- Cultured dairy products, sour cream, buttermilk, yogurt
Disclude triggers from your diet. Severe hemiplegic migraine attacks can rarely cause permanent brain injury, cerebral atrophic, cognitive decline, and death. Seizures independent of hemiplegic migraine attacks have been reported in some patients of the condition.
How is hemiplegic migraine diagnosed?
Hemiplegic migraine is diagnosed based on the presence of specific signs and symptoms. Genetic testing is not necessary for all affected people.
Brain imaging is usually normal in individuals with hemiplegic migraine. A minority of individuals affected by hemiplegic migraine associated with permanent cerebellar symptoms have an atrophy of the cerebellum.
Molecular genetic testing can confirm a diagnosis of familial hemiplegic migraine in some individuals. Molecular genetic testing can detect mutations in specific genes known to cause the disorder, but is available only as a diagnostic service at specialized laboratories.
It is pertinent to consult a professional before making any diagnosis by yourself.
Treatment of hemiplegic migraine
The goal of treatment of hemiplegic migraine is prevention and symptom management. It will include the use of medications, such as:
- anti-nausea/vomiting medications (antiemetics)
- pain medications, including narcotics and non-steroidal anti-inflammatory drugs(NSAIDs)
- calcium channel blockers
- beta blockers
- anti-seizure medications
- nasal ketamine
- intravenous verapamiltricyclic antidepressants
Due to the risk of stroke, certain medications are not recommended for people with hemiplegic migraine. These include drugs that constrict blood vessels, such as triptans and ergotamines.
There is little conclusive research as yet to establish a single best course of drug treatment for hemiplegic migraine.
Exercise regularly to make your migraine attacks endurable. Hemiplegic migraine has long been considered a painful condition that affects quality of life but it is not otherwise dangerous.