I Suffer From Hemiplegic Migraine

Hemiplegic Migraine Treatment

Hemiplegic Migraine (HM) has an unusual and often alarming presentation that can mimic stroke, multiple sclerosis, epilepsy or metabolic disorders. Hemiplegia is a condition where one side of the body is weakened or paralysed.

Hemiplegic migraine is a rare form of migraine and subcategory of migraine with aura. During hemiplegic migraine attacks sufferers will experience weakness or paralysis of one side of the body, as well as more typical migraine aura symptoms such as visual, sensory, or speech disturbances. Severe hemiplegic migraine attacks may even require hospitalisation, especially in instances where the sufferer experiences changes in consciousness, high fever, or seizures.

Read more and learn how our treatment is effective in alleviating or dramatically reducing migraines in 85-90% of sufferers.

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Hemiplegic Migraine Treatment - Sydney Headache & Migraine Clinic

Understanding Your Migraine

Hemiplegic Migraine Symptoms

Symptoms for Hemiplegic Migraine may include:

Severe migraine headache, usually on one side of the body
Weakness or paralysis of one side of the body
Loss of muscle control
Inability to comprehend or formulate language
Numbness or tingling in the face and/or limbs
Dizziness
Drowsiness
Flashing lights in the vision, double vision, or other visual disturbances

As a result of the alarming symptoms that are displayed in HM (Hemiplegic Migraine), diagnoses must exclude all other possible conditions that present similarly. Some examples include severe migraine with aura, multiple sclerosis, metabolic disorders, conversion disorder, facial palsy, stroke or epilepsy. Another characteristic that can differentiate HM from classical migraine with aura is that minor head trauma can trigger HM.

Read about the types of Hemiplegic Migraines

Understanding Your Migraine

What is the cause of Hemiplegic Migraine?

Hemiplegic migraines often have a genetic component. However, they can also be triggered by head trauma(1), whether it be mild or severe.

In those individuals that may be suffering from Hemiplegic Migraine and have no underlying pathology or disorder that can be recognised, another known cause may be due to a sensitised brainstem(2).

A SENSITISED BRAINSTEM will perceive non-threatening stimuli and create pain to be felt where the sensory information was originally detected. This hyperexcitability of the pain sensation is due to the heightened arousal and sensitive brainstem, and may be associated with a phenomenon called cortical spreading depression. A sensitive brainstem will relay the sensory information to the brain, but will heighten the sensation so that the brain perceives the information as painful.

Organise Your Initial Assessment

About The Assessment Stage

What To Expect During The Assessment

1. Comprehensive and in-depth examination

We instigate an in-depth assessment to identify all possible related factors that could be causing your headaches or migraines. The upper cervical spine, in particular, is thoroughly examined to identify possible issues.

2. Ligamental stability and vertebral arterial tests

We undertake careful examination of neck ligaments and vertebral arteries, ensuring only the highest standards of patient safety and comfort.

3. Temporarily reproduce your headache and migraine symptoms

As a part of the treatment process, we apply gentle and selective stress to the upper cervical spine in order to reproduce headache symptoms, which subside after 20-30 seconds. This helps to identify and treat the cause of your headaches.

Hemiplegic Migraine – Quick Facts & FAQs

What is hemiplegic migraine?

Hemiplegic migraine is a subtype of migraine with aura in which the aura includes fully reversible motor weakness. Motor weakness may occur with other reversible aura symptoms, including visual disturbance, sensory symptoms, and speech or language changes.

Because the presentation can overlap with acute neurological conditions, first presentations or atypical events require urgent assessment.

Familial Hemiplegic Migraine

This subcategory of Hemiplegic Migraines refers to a sufferer with hemiplegic migraine in their family history. In cases of familial hemiplegic migraine, the patient has one or more first- or second-degree relatives that suffer from the same condition. There are several genes that have been identified that can contribute to this condition.

Sporadic Hemiplegic Migraine

This subcategory of Hemiplegic Migraines refers to a sufferer that does not have any close relatives that suffer from the same condition1. In some cases, similar gene mutations have been found in sporadic hemiplegic migraine patients. This is referred to as “Sporadic Gene Mutation”, hence the name Sporadic Hemiplegic Migraine.

There are no significant differences in the prevalence of the two types of Hemiplegic Migraines. Hemiplegic Migraines often present with brainstem symptoms, in addition to the normal aura symptoms. They are often mistaken for epileptic attacks and unsuccessfully treated as such.

What causes hemiplegic migraine?

Hemiplegic migraine is associated with altered neuronal excitability and changes in signalling pathways involved in aura. Familial forms have been linked to variants in genes such as CACNA1A, ATP1A2, and SCN1A in some families, supporting an “ion channel / transport” mechanism in at least a subset of cases. Sporadic hemiplegic migraine follows the same clinical pattern without a known family history.

How rare is hemiplegic migraine?

Hemiplegic migraine is very rare. Population studies have estimated prevalence at approximately 0.01% (around 1 in 10,000), noting that figures vary depending on diagnostic confirmation and study design.

How to prevent hemiplegic migraine

Prevention is typically multi-factorial: improving sleep regularity, minimising missed meals, maintaining hydration, reducing stress load, and monitoring triggers with a structured diary. Depending on frequency and severity, medical prevention may be considered through an appropriate treating clinician. The goal is to reduce attack likelihood and lower overall neurological sensitivity.

What foods cause hemiplegic migraine?

No single food causes hemiplegic migraine for everyone. Dietary triggers are individual and often interact with other factors such as sleep disruption, stress, dehydration, and fasting. Commonly reported migraine-related triggers include alcohol, aged cheeses, cured/processed meats (nitrates/nitrites), MSG, and artificial sweeteners.

How Do I Know If I Have a Hemiplegic Migraine?

(Attacks fulfilling criteria A-B)

Migraine features	Attacks fulfilling the criteria of Migraine
Aura symptoms	Aura consists of both the following: – Fully reversible motor weakness – Fully reversible visual, sensory and/or speech/language symptoms

I’ve already tried everything. How else can be done to treat my Hemiplegic Migraine?

Treating your Hemiplegic Migraine

Over-the-counter painkillers, strong triptan medications, and even tricyclic antidepressants are some of the ways in which Hemiplegic Migraine sufferers have attempted to rid themselves or their children of the painful attacks. In some cases, these ways can alleviate the symptoms of a hemiplegic migraine attack. However, despite all of these treatment options, sufferers may still find themselves having painful attacks.

At the Sydney Headache and Migraine Clinic™, we have seen countless Hemiplegic Migraine sufferers. So, if you suffer from Hemiplegic Migraine, or if you think it sounds like your symptoms, and medication has given you no significant relief, then we believe that you should have a thorough examination of your brainstem. During your initial consultation, your headache clinician should be able to reproduce your hemiplegic migraine pain, by applying pressure in one of the first three vertebrae of your neck.

If your symptoms can be reproduced and resolved, expect a significant improvement to occur rapidly. Our treatment is effective in alleviating or dramatically reducing migraines in 85-90% of sufferers.