About HM

Hemiplegic
Migraines

Hemiplegic migraine (HM) is a rare form of migraine that is characterized by an aura consisting of unilateral weakness along with other symptoms such as impairment of vision speech, or sensation. Women are three times more likely to have the condition than men and 0.01% of the population is affected. The average onset is 12 to 17 years. However, many women in the Women's International Hemiplegic Migraine Group experienced their first HM in their 30's and 40's. On average, 50% of children who have a parent with HM will develop this disorder.

There are two types of hemiplegic migraine: Familial and sporadic. Familial hemiplegic migraine is caused by abnormal variation in three genes: the CACNA1A gene, the APT1A2 gene, and the SCN1A gene. There is usually a family history of hemiplegic migraines in affected individuals. If an individual is the first person in their family with hemiplegic migraine, they are described as having sporadic hemiplegic migraine. Sporadic hemiplegic migraine is very likely to be considered a genetic disorder.

Quick Facts

0.01%

HM has a prevalence of only 0.01% along the population.

Women are three times more likely to have the condition than men.

12-17

This is average onset age for HM to occur.

There are two types - familial and sporadic.

Diagnosis

When it comes to the diagnosis of hemiplegic migraine, a medical professional will conduct a thorough examination of the individual's symptoms and family history. It is important to note that to receive a diagnosis of hemiplegic migraine, the person must have experienced at least two episodes of this particular type of migraine. The diagnosis itself requires the presence of temporary symptoms that are related to motor weakness, vision, senses, or speech. These symptoms must also have at least two of the following characteristics: at least one neurological symptom that spreads gradually over 5 minutes or more, two or more symptoms that occur in succession, each non-motor symptom lasting for 5–60 minutes, and motor symptoms lasting for up to 72 hours, at least one symptom on one side only, and the visual, sensory, or motor symptom accompanied or followed by a headache within 1 hour.It is also important to note that for a correct hemiplegic migraine diagnosis, the doctor must rule out all other potential causes of the symptoms, including a transient ischemic attack, a stroke, and a seizure, as these conditions can present with similar symptoms. Therefore, a thorough examination and evaluation of the individual's medical history is necessary to ensure an accurate diagnosis.

Symptoms

Primary symptoms include weakness on one side of the body (hemiplegia), headache, and other type of aura symptoms, such as vision changes, numbness, tingling, and trouble speaking. Hemiplegia is a distinct aura symptom that characterizes these disorders.

During the hemiplegic migraine attack, vision is usually affected temporarily and can include the appearance of a bright light in the center of the field of vision causing blind spots, double vision or flashing lights, and bright shimmering, jagged lines. Additional symptoms include numbness or a prickly sensation of the face or arms and legs (paresthesia), fever, imbalance, drowsiness, and an inability to understand or express speech (aphasia). The pain can cause nausea or vomiting and the affected individual may be extremely sensitive to light (photophobia) and sound (phonophobia). In severe cases, affected individuals may experience prolonged weakness, seizures, confusion, memory loss, and personality or behavioral changes. During such severe attacks, weakness or speech troubles can last for several days or weeks but there is usually a full recovery.

Similar to common migraines, there are a variety of 'triggers' that can cause a hemiplegic migraine attack. Triggers that can cause an episode of hemiplegic migraine include certain foods, certain odors, bright light, too little or too much sleep, physical exertion, stress, or minor head trauma. Cerebral angiography can also trigger an episode. This is a type of X-ray exam that is used to assess the health and function of blood vessels in the brain. Sometimes, there are no identifiable triggers when an episode occurs.

Because the symptoms of hemiplegic migraine are similar to stroke, seizures, and other potentially serious neurological conditions, it's important to be diagnosed by a neurologist to receive a clear diagnosis.

Treatment

Hemiplegic migraine treatment is personalized to address the specific symptoms of each individual. A team of specialists, including neurologists, headache, ophthalmologists, holistic practitioners, social workers, and other healthcare professionals, may be required to provide treatment. Psychosocial support can be beneficial to the entire family.

Various medications can be used to treat migraine attacks. Analgesics and non-steroid anti-inflammatory drugs are effective in reducing headaches. However, triptans and ergotamine may not be suitable for treating hemiplegic migraine due to their tendency to narrow blood vessels, which increases the risk of stroke. Other medications used include tricyclic anti-depressants, beta-blockers, and calcium channel blockers. Anti-seizure medications can also be used to treat seizures that are common in familial hemiplegic migraine. Botox injections have been proven effective in treating hemiplegic migraine. Additionally, the new CGRP inhibitors are a preventive medicine class for treating common migraines and may help treat hemiplegic migraines.

The best approach to treating hemiplegic migraine is by combining traditional and homeopathic medicine. Alternative migraine treatments, such as meditation, mindfulness training, acupuncture, essential oils, or vitamins and minerals, can be used in conjunction with traditional medicine. Up to 80% of patients living with migraine have tried alternative treatments. Holistic treatments are to be used in conjunction with traditional medicine.

HM & Disability

Chronic migraine may qualify as a disability under the American Disability Act (ADA) if it affects an individual's ability to perform certain activities, such as working or concentrating. However, the U.S. Social Security Administration (SSA) does not currently list migraines as a disability. Migraine is currently the second-highest cause of disability and the first among young adults, with an estimated global prevalence of 15.2%.

Many women in the Women's International Hemiplegic Migraine Group have been unable to work due to hemiplegic migraine episodes. They have had to leave their places of work, where they have been for many years, and apply for disability. Unfortunately, less than half of those who apply for disability are approved. The Women's Hemiplegic Migraine Alliance advocates for changes in disability rulings. It is essential to be able to apply for disability and be approved when we can no longer work when hemiplegic migraine episodes become too severe.