Hemiplegic Migraines are a rare type of migraine disorder which involve single sided weakness and aura/sensory symptoms. This can be due to genetics or can occur spontaneously in certain individuals.
Symptoms can range in intensity and can last for a few days and in severe cases a few months. The motor symptoms will tend to last longer than the headache symptoms and these will often present quite similar to a stroke. In the majority of cases patients will tend to make a full recovery.
Triggers can be things such as stress, lack of sleep, emotional distress and physical exertion. Women are three times more likely to be affected and average age of onset of symptoms is between 12 and 17 years of age.
Diagnostic criteria for Hemiplegic migraines is as follows:
At least 2 attacks fulfilling the criteria 2 and 3
Aura consisting of both of the following:
- Fully reversible motor weakness
- Fully reversible visual, sensory and/or speech/language symptoms
At least 2 of the following 4 characteristics:
- At least one aura symptom spreading gradually over at least 5 minutes, and/or at least 2 symptoms occurring in succession
- Each non-motor symptom lasts 5 to 60 minutes, and motor symptoms last less than 3 days
- At least one aura symptom is unilateral
- Aura is accompanied or followed by a headache within 30 minutes.
Given how similar presentations are to a stroke or TIA, CT’s, MRI’s and spinal punctures may be needed to rule out any other pathologies.
The attacks are managed with preventative medications which are taken ongoing for the life of the individual. Though as patients get above the age of 50 the occurrence of motor symptoms tends to reduce and they are more likely to be affected only with migraine and aura symptoms.
Motor symptoms can be treated similar to that of acute stroke rehab and provided all scans are clear of any tissue damage there should be full symptoms resolution in an accelerated time frame.