Chapter 1, Episode 5: What is Hemiplegic Migraine?


This content has been medically reviewed by Dr. Deena Kuruvilla.

Hemiplegic migraine is a rare type of migraine affecting around 800,000 people worldwide.1

The average age of onset is between 12-17 years old and women are three times more likely to be diagnosed with this condition.1

Hemi means half and plegic means paralysis. The distinguishing symptom of hemiplegic migraine is one sided weakness or paralysis. Attacks may be accompanied by a headache or one can follow shortly after. 

The weakness is a form of aura and is accompanied by at least one other aura symptom such as visual changes. The weakness is not always on the same side as the head pain and can vary from mild to severe. Most individuals who experience hemiplegic migraine also experience more typical migraine attacks. 

Hemiplegic migraine may affect only part of the body, such as the face or a hand or arm. Weakness of the entire side of the body can also occur. Symptoms can also include loss of balance and coordination, difficulty speaking, fever, dizziness, impaired consciousness and brain fog.

There are two types of hemiplegic migraine:

  • One is sporadic hemiplegic migraine which happens in a person without a family history of hemiplegic migraine. Although, gene mutations may still be involved.
  • The second is known as familial hemiplegic migraine where 1 or more first degree relatives also have this condition.

So far, scientists have found abnormal defects in four genes related to familial hemiplegic migraine:

  1. CACNA1A
  2. ATP1A2  
  3. SCN1A
  4. PRRT2

At least 25% of families don’t have any of these 4 mutations, leading scientists to believe more genes could be involved.1

Hemiplegic migraine can also be the result of brain trauma.

Treatment is similar to classic migraine with aura with the exception of triptans and ergot alkaloids. These medications can cause constriction of blood vessels and increase the risk of stroke. NSAIDs and anti-nausea medications are abortive choices as well as intranasal ketamine for familial hemiplegic migraine.Verapamil can be used as a preventive therapy. For prevention, beta blockers remain controversial. Other preventative options include: ketamine, acetazolamide, naloxone, flunarizine and for non responders lamotrigine may be effective.1 

A hemiplegic migraine attack can closely resemble a transient ischemic attack or stroke. If you believe you are having a hemiplegic migraine attack go to the emergency room and do not self diagnose. A CT scan or MRI can rule out stroke. Remember, those with hemiplegic migraine can also have a stroke and it may be difficult to distinguish. Examination by a headache specialist is necessary.



This video is sponsored in part by Amgen, AbbVie, Lilly, and Lundbeck.

*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.