Hemiplegic Migraine: Understanding Stroke Risk And Connection

Hemiplegic migraine is a rare and severe form of migraine that can cause temporary paralysis on one side of the body. The symptoms of a hemiplegic migraine attack can be very similar to those of a stroke, so it is important to get an accurate diagnosis. While hemiplegic migraine attacks have similar symptoms to a stroke, they do not cause a stroke. However, there may be other links between stroke and migraine aura more generally.

Hemiplegic migraine symptoms

Hemiplegic migraine is a rare and serious type of migraine with symptoms that can mimic those of a stroke. The symptoms can be frightening and range from worrying to disabling. However, unlike stroke symptoms, they come on slowly and build up before going away.

Early Warning Signs

You may experience early warning signs before the actual headache pain. These early symptoms, called auras, can cause:

• Short-term trouble with muscle control and sensation
• A pins-and-needles feeling, often moving from your hand up your arm
• Numbness on one side of your body, which can include your arm, leg, and half of your face
• Weakness or temporary paralysis on one side of your body
• Loss of balance and coordination
• Dizziness or vertigo
• Seeing zigzag lines, double vision, or blind spots
• Extreme sensitivity to light, sound, and smell
• Language difficulties, such as mixing words or trouble remembering a word
• Drowsiness or loss of consciousness

Auras usually develop gradually over half an hour and can last for several hours before slowly resolving. They tend to be more severe and longer-lasting than with other types of migraines.

Primary Symptoms

The primary symptoms of a hemiplegic migraine include:

• Weakness or temporary paralysis on one side of the body (hemiplegia)
• Aura symptoms, such as vision changes, numbness, tingling, and trouble speaking
• Changes in consciousness, ranging from confusion to a profound coma
• Problems with coordination
• Increased sensitivity to sound and light

Other Possible Symptoms

In severe cases, individuals with hemiplegic migraine may experience:

• Prolonged weakness
• Seizures
• Confusion
• Memory loss
• Personality or behavioural changes
• Coma
• Uncontrolled, repetitive eye movements (nystagmus)
• Slurred speech (dysarthria)
• Lack of coordination of voluntary movements (ataxia)

Diagnosis and Treatment

Due to the similarity of symptoms with a stroke, it is important to seek medical attention to receive a clear diagnosis. Doctors will review your medical history, perform a neurological exam, and may order scans to examine your brain and blood vessels.

There is no single 'best' treatment for hemiplegic migraines. Doctors may prescribe drugs to prevent migraines, stop them once they've started, or relieve symptoms. It is recommended to discuss these options with your doctor.

Hemiplegic migraine causes

Hemiplegic migraine is a rare and serious type of migraine with symptoms that can mimic those of a stroke. The causes of hemiplegic migraines are not yet fully understood, but researchers have identified four genes linked to the condition.

Hemiplegic migraine is characterised by weakness on one side of the body, known as hemiplegia, along with a headache and other symptoms that overlap with typical migraine symptoms. These additional symptoms, known as aura, can include changes in vision, speech, sensation, and mental status. The weakness experienced during an attack of hemiplegic migraine is always associated with at least one other aura symptom.

In some cases, hemiplegic migraine occurs due to a change or mutation in one of four specific genes: CACNA1A, ATP1A2, SCN1A, and PRRT2. This form is called familial hemiplegic migraine, and it is inherited in an autosomal dominant pattern, meaning a child of a parent with the condition has a 50% chance of inheriting it. However, not all cases of familial hemiplegic migraine can be attributed to these four genes, and researchers suspect there may be additional genes that cause the disorder that have not yet been identified.

In other cases, individuals may be the first in their family to experience hemiplegic migraine, and these cases are referred to as sporadic hemiplegic migraine. Sporadic cases may be due to a de novo variation of one of the three genes associated with the disorder or may be inherited from an asymptomatic parent.

Like other types of migraines, hemiplegic migraines can be triggered by various factors, including certain foods, odours, bright lights, sleep patterns, physical exertion, stress, and head trauma. However, sometimes there are no identifiable triggers for an episode.

Hemiplegic migraine diagnosis

Hemiplegic migraine is a rare disorder that can cause stroke-like symptoms, including temporary paralysis on one side of the body. Due to the similarity of symptoms, it is often hard to distinguish a hemiplegic migraine from a stroke. Therefore, it is crucial to seek immediate medical attention and not self-diagnose.

To diagnose hemiplegic migraines, doctors will typically perform a thorough neurological exam and review the patient's medical history. They may also order brain imaging scans, such as a CT scan or an MRI, to rule out other conditions, such as a stroke. Additionally, tests on the heart and blood vessels in the neck can help rule out blood clots as a cause of the symptoms.

If there is a family history of similar symptoms, genetic testing may be recommended to determine if the patient has familial hemiplegic migraine (FHM) or sporadic hemiplegic migraine (SHM). FHM is inherited, while SHM occurs in individuals with no family history of the condition.

During the diagnostic process, doctors will also consider other disorders with similar symptoms, such as alternating hemiplegia of childhood (AHC), MELAS syndrome, MERFF syndrome, CADASIL, hereditary hemorrhagic telangiectasia, and retinal vasculopathy with cerebral leukodystrophy.

Hemiplegic migraine treatment

Acute Treatment

• NSAIDs – Nonsteroidal anti-inflammatory drugs can be used to treat acute migraine episodes.
• Antiemetics – Drugs like metaclopramide (Reglan) can help with nausea and vomiting.
• Intranasal ketamine – This medication, taken through the nose, may shorten the aura phase.
• Calcium channel blockers – Verapamil can be used as a prophylactic and abortive agent.
• Anticonvulsants – Topiramate (Topamax) can be used preventively.
• OnabotulinumtoxinA (Botox) – Can be used preventively.
• Beta-blockers – These are a common preventive medication for migraines, but they may increase the risk of cerebrovascular conditions like strokes in people with hemiplegic migraines.
• Triptans and ergotamines – These are not recommended for people with hemiplegic migraines as they may increase the risk of stroke.
• Detans – A newer class of medications that don't constrict blood vessels like triptans and ergotamines.

Preventive Treatment

• Tricyclic antidepressants – Can be used to reduce the frequency of attacks.
• Calcium channel blockers – Can be used to reduce the frequency of attacks.
• Beta-blockers – Can be used to reduce the frequency of attacks, but they may increase the risk of cerebrovascular conditions like strokes in people with hemiplegic migraines.
• Anti-seizure medications – Can be used preventively, especially in people with hemiplegic migraine type 2.
• Anticonvulsants – Lamotrigine can be used preventively, particularly in patients who have predominant aura symptoms.
• Other preventive medications – Amitriptyline, valproic acid, and flunarizine can be used preventively.
• Lifestyle changes – These can help reduce the frequency and severity of migraine attacks.

Hospitalization

In severe cases, hospitalization may be required, especially if there is a high fever, depressed consciousness, or seizures. Intravenous steroids may be used in cases of brain edema.

Hemiplegic migraine vs stroke

Hemiplegic migraine is a rare and serious type of migraine headache. It involves muscle weakness on one side of the body, which doctors call hemiplegia. Many of its symptoms are similar to those of a stroke, such as:

• Temporary paralysis on one side of the body
• Loss of balance and coordination
• Language difficulties
• Numbness on one side of the body
• Seeing zig-zag lines, double vision, or blind spots
• Extreme sensitivity to light, sound, and smell

However, there are some key differences between hemiplegic migraines and strokes. Here are some ways to distinguish between the two:

Onset of Symptoms:

• Hemiplegic migraine symptoms typically come on gradually and can last for hours before slowly resolving.
• Stroke symptoms, on the other hand, tend to occur suddenly and abruptly.

Nature of Sensations:

• Migraines typically cause positive sensations, such as feeling tingly, prickly, or seeing spots.
• Strokes, on the other hand, are associated with the absence of sensations, such as feeling numb, weak, or experiencing vision loss.

Pain:

• Migraines are often characterised by a throbbing, intense, and debilitating pain, typically on one side of the head.
• Strokes can also cause a sudden, very severe headache, but this is not always the case.

Frequency:

• Hemiplegic migraines can occur in episodes, ranging from about one a day to fewer than five in a lifetime, with long episode-free periods in between.
• Strokes are typically singular events, though a person can have multiple strokes over their lifetime.

Duration:

• Hemiplegic migraine symptoms can last for a few hours to several days.
• Stroke symptoms can have long-lasting physical, cognitive, and emotional effects and may result in permanent damage to the brain.

Risk Factors:

• People with hemiplegic migraines have about a 50% chance of passing it on to their children.
• Risk factors for stroke include high blood pressure, high cholesterol, smoking, obesity, and diabetes.

While hemiplegic migraines and strokes share some similar symptoms, it is important to note that having a hemiplegic migraine does not cause a stroke. However, people with migraine with aura, in general, have a slightly higher risk of stroke. If you are experiencing any stroke-like symptoms, it is always best to seek immediate medical attention.

Frequently asked questions