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Hemiplegic Migraine - The Basics

by Teri Robert, Lead Health Guide

PLEASE NOTE: Due to new research and changes in the International Headache Society's International Classification of Headache Disorders, this article has been replaced by an updated article, Sporadic and Hemiplegic Migraine - The Basics.


To understand Hemiplegic Migraine, we have to understand that Migraine attacks are episodic manifestations of a genetic neurological disease. Migraine can present in a variety of ways. Hemiplegic Migraine is a rare form of Migraine, made more confusing by there being two variations: Familial Hemiplegic Migraine (FHM) and Sporadic Hemiplegic Migraine (SHM).

Diagnosing FHM and SHM can be difficult as the symptoms are also indicative of vascular disease. and can be thought to be stroke, epilepsy, or other conditions. A full neurological work up and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of FHM or SHM. Family medical history is especially helpful in diagnosing FHM.

FHM and SHM share the same symptoms, which will vary among different Migraineurs. The difference between the two is that FHM can be traced back in the family history and has been linked to mutations of specific genes on chromosomes 1 and 19. SHM is FHM without the familial connection and that particular genetic mutation.

Symptoms of FHM and SHM:

  • Episodes of prolonged aura (up to several days or weeks)

  • Hemiplegia (paralysis on one side of the body)

  • Fever

  • Meningismus (symptoms of meningitis without the actual illness and accompanying inflammation)

  • Impaired consciousness ranging from confusion to profound coma

  • Headache, which may begin before the hemiplegia or be absent

  • Ataxia (defective muscle coordination)

  • The onset of the hemiplegia may be sudden and simulate a stroke.¹

  • Nausea and/or vomiting

  • Phonophobia and/or photophobia

Treatment of FHM and SHM:
Treatment of Hemiplegic Migraine can be challenging. The symptoms are greater in number and more difficult to treat. Those who experience Hemiplegic Migraines absolutely need to educate themselves about their disease and treatment. It's very common to need to seek the care of an excellent Migraine specialist with an established track record for treatment as many other doctors have never treated a case of Hemiplegic Migraine.

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