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What Is A Hemiplegic Migraine

Treatment Of Hemiplegic Migraine

Hemiplegic Migraine

Hemiplegic migraine treatment is not usually a straightforward process. The treatments generally focusing on symptom management as opposed to elimination of the condition. The doctor must take into consideration a variety of factors, including:

  • The severity of the symptoms
  • Identifying and focusing on the symptoms that are the most problematic for the patient

Dr. Khorsandi adds, Like most migraines, the causes and treatments will vary from person to person. For those who have the familial type, it can at least be traced back through the family and a treatment plan can be created.

Not Classified In The Ichd

Acephalgic migraine is a neurological syndrome. It is a variant of migraine in which the patient may experience aura symptoms such as scintillating scotoma, nausea, , hemiparesis and other migraine symptoms but does not experience headache. Acephalgic migraine is also referred to as amigrainous migraine, ocular migraine, ophthalmic migraine or optical migraine, the last three of which are misnomers.

Sufferers of acephalgic migraine are more likely than the general population to develop classical migraine with headache.

The prevention and treatment of acephalgic migraine is broadly the same as for classical migraine. However, because of the absence of “headache”, diagnosis of acephalic migraine is apt to be significantly delayed and the risk of misdiagnosis significantly increased.

Visual snow might be a form of acephalgic migraine.

If symptoms are primarily visual, it may be necessary to consult an optometrist or ophthalmologist to rule out potential eye disease before considering this diagnosis.

Comparison Of Symptoms In Fhm And Ma

FHM has a lower age at onset compared with MA, which could be due to a higher genetic load. Lifetime number of attacks varied to the same degree in both conditions. The type of symptoms and their order of appearance were similar in FHM and MA. However, major clinical differences support that FHM and MA are separate entities. For example, FHM usually had more than two aura symptoms, and the duration of each was longer than in MA. Basilartype migraine symptoms were often present during FHM attacks but not during MA, and FHM was accompanied more often by headache.

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Prevention And Risk Factors

Attacks of hemiplegic migraine often start in childhood or young adulthood. Youre more likely to have this type of headache if it runs in your family.

If one of your parents has hemiplegic migraine, you have a 50 percent chance of also getting these headaches, according to the Stroke Association.

You may not be able to prevent hemiplegic headaches if they run in your family. However, you can take medication to help reduce the number of headaches you get.

Another way to help prevent these migraine attacks is to avoid any factors that trigger your headaches.

Can You Prevent Complex Migraine

Hemiplegic Migraine Guide

If you can link your migraine to environmental triggers like the smell of cigarette smoke or drinking red wine you can usually avoid these to prevent complex migraine. Stress may be more difficult to avoid, but not impossible.

To treat complex migraine, doctors may also prescribe medications that may help brain chemistry. You may need to try different treatments or combinations of treatments before you find one that may help reduce migraine days.

Examples of preventive treatments may include:

  • antiseizure medications
  • beta-blockers
  • calcium channel blockers

If you rarely have migraine, doctors dont usually recommend the above treatments. Preventive medications are usually reserved for people who have migraine days frequently, which interfere with their daily activities.

Researchers have detected changes in three genes that may cause hemiplegic migraine or those that lead to weakness on one side if your body. Specifically, these genes are:

  • ATP1A2
  • SCN1A

These genes help with nerve cell function in your brain. However, doctors havent defined how changes in these genes lead to migraine.

If you have a family history of complex migraine, youre more at risk of developing this type.

NORD defines the inheritance pattern as a 50 percent risk that a parent will pass the gene on to a child with each pregnancy.

However, many people with complex migraine dont have a family member with this migraine type.

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Symptoms Of Hemiplegic Migraine

  • Phonophobia and/or photophobia

The symptoms can last for hours to days, or rarely weeks, but most resolve completely.

Please refer to the International Classification of Headache Disorders 3rd edition website for more information on the criteria used to diagnosis hemiplegic migraine:

What Is Complex Migraine

Complex migraine causes an aura before migraine that includes stroke-like symptoms.

An aura is a symptom that migraine is coming. When a person has complex migraine, this aura often lasts longer than it does for people who have other types of migraine.

The term complex migraine isnt one that doctors use as frequently as they may have a decade ago.

Complex migraine is no longer a frequent term because the term is often a catch-all term that describes migraine symptoms that cause:

  • stroke-like symptoms
  • migraine with auras that lasted longer than typically expected

This article explores all three of these complex migraine symptoms.

A lack of a clear complex migraine definition led doctors to start using more specific clinical terms to describe them.

An example of a clinical term is a rare migraine type called hemiplegic migraine. It causes weakness or paralysis on one side of your body due to an aura.

Ophthalmoplegic migraine causes pain around your eye and visual changes that may last several weeks due to migraine. These descriptions allow doctors to more specifically define complex migraine.

Some people experience complex migraine on a weekly basis while others may only experience this once or twice in their lifetimes. As a general rule, a person has fewer migraine episodes as they get older.

Some people may be able to link their complex migraine to certain triggers. Examples of common migraine triggers include:

  • eating certain foods
  • smelling strong smells
  • stress

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Familial And Sporadic Hemiplegic Migraine

Familial hemiplegic migraine is migraine with a possible polygenetic causeâin fact, FHM can only be diagnosed when at least one close relative has it too. The patient experiences typical migraine with aura headache either preceded or accompanied with one-sided, reversible limb weakness and/or sensory difficulties and/or speech difficulties. FHM is associated with ion channel mutations.

There also exists the “sporadic hemiplegic migraine” , which is the same as FHM but with no close family members showing the symptoms.

Effecting a differential diagnosis between basilar migraine and hemiplegic migraine is difficult. Often, the decisive symptom is either motor weakness or unilateral paralysis, which occur in FHM and SHM. Basilar migraine can present tingling and numbness, but true motor weakness and paralysis occur only in hemiplegic migraine.

Diagnostic criteria for Menstrually-related migraine without aura A. Attacks, in a menstruating woman, fulfilling the criteria for migraine without auraB. Attacks that occur exclusively from days -2 to +3 of menstruation in at least two out of three menstrual cycles, and additionally at other times of the menstrual cycle.

Note: The first day of menstruation is day +1, and the preceding day is day -1 there is no day 0.

International Headache Society

What Is On The Horizon

Migraine Headaches : About Hemiplegic Migraines

Hemiplegic migraines are rare and there isnt much research regarding treatments, but it is slowly coming onto the radar of key players in migraine research. Xenon, a clinical stage biopharmaceutical company is currently conducting research on hemiplegic migraines to better understand hemiplegic migraine patients symptoms and their experiences with the condition so that they can develop better treatments. The condition is gaining attention and more studies are expected to start up as more awareness is brought to the condition. In the meantime, there are treatments that do work and provide at least some relief. Dr. Khorsandi sums it up very well.

You may be prescribed an anticonvulsant or heart medication to widen blood vessels if you are suffering from this type of migraine, he says. There is little research on these migraines, but migraine doctors are opening up new types of medication that can help with these attacks. We recommend keeping a migraine diary to track triggers of an attack, or consult a doctor or neurologist specially trained in migraines.

In other words, theres hope on the horizon.

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Summary Of Hemiplegic Migraines

Because symptoms of hemiplegic migraine are also symptoms of other conditions such as stroke and epilepsya hemiplegic migraine attack can be quite frightening, both to the migraineur and to those witnessing the attacks. Proper diagnosis and treatment are especially essential with this form of migraine. Imaging studies and other testing should be performed to rule out other causes of the symptoms. It is important that people with hemiplegic migraine understand their migraines as well as possible. With continuing research, especially genetic research, more is being learned about hemiplegic migraine. As this research continues, living with hemiplegic migraine will become easier.

Table 1 Diagnostic Criteria For Hemiplegic Migraine

A. At least 2 attacks fulfilling criteria B and C B. Aura consisting of both of the following:

Fully reversible motor weakness Fully reversible visual, sensory, and/or speech/language symptoms

C. At least 2 of the following 4 characteristics:

At least 1 aura symptom spreads gradually over more than or equal to 5 minutes, and/or 2 or more symptoms occur in succession Each individual nonmotor aura symptom lasts 5 to 60 minutes, and motor symptoms last less than 72 hours At least 1 aura symptom is unilateral The aura is accompanied, or followed, within 60 minutes by headache

D. Not better accounted for by another ICHD-3 diagnosis, and transient ischemic attack and stroke have been excluded

Familial hemiplegic migraine. Familial hemiplegic migraine is migraine with aura including motor weakness, and at least 1 first- or second-degree relative has migraine aura including motor weakness.

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Hemiplegic Migraine: 5 Things I Wish Id Known

This post may contain affiliate links. Migraine Strong, as an Amazon Affiliate, makes a small percentage from qualified sales made through affiliate links at no cost to you.

I was diagnosed with Hemiplegic Migraine only a year ago, in 2019, after a few years of struggling for a diagnosis for some odd symptoms and experiences. Here are five things I wish Id known when I was trying to get diagnosed and when I was newly diagnosed.

Identifying And Avoiding Triggers

Hemiplegic Migraine: What Are Its Causes, Triggers and ...

Next, the persons migraine triggers must be identified and avoided. Each person may have a different combination of triggers. A migraine journal can be used to record your migraine symptoms, what time of day you have them, what occurred before the symptoms began, how long they last, and the severity. This will help you identify and later avoid your migraine triggers and your doctor accurately diagnose what type of migraine you have.

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The Basics About Hemiplegic Migraine

Migraine can present in a variety of ways. Hemiplegic migraine is a rare form of migraine where people experience weakness on one side of their body in addition to the migraine headache attack. The weakness is a form of migraine aura and occurs with other forms of typical migraine aura like changes in vision, speech or sensation. Hemiplegic migraine is divided into Familial hemiplegic migraine or Sporadic hemiplegic migraine . This is a very rare migraine type so if you ever experience new or never-evaluated weakness with your headache, you should seek immediate medical evaluation and not assume you have hemiplegic migraine.

Both familial and sporadic hemiplegic migraines often begin in childhood. Diagnosing hemiplegic migraine can be difficult, as the symptoms can mimic stroke, seizures or other conditions. A full neurological work up, including obtaining imaging of the brain and vessels in the head, and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of hemiplegic migraine. Family medical history is especially helpful in diagnosing familial hemiplegic migraine.

Symptoms Continue To Progress

Then my leg went heavy and was dragging around. I went back to the doctor. Again an MRI. Again clean. With every new symptom arm involvement, face drooping, slurred speech, lost speech, confusion, pain, and moremy doctors would do an MRI or send me to a specialist for this, and a specialist for that. At one point, they even suggested that perhaps my anxiety was creating the symptoms. And I did have anxiety.

I felt like my body was betraying me. Id wilt on my right side, unable to lift my arm or leg without vast amounts of effort. My head would feel so heavy that my neck was unable to lift it. My speech would slur. Words were hard to find. And sometimes they left altogether, and I would be lost with my thoughts but no way to speak them.

In this darkness and confusion and fear, I found a glimmer of light in a blog post by Erica Carrasco. She wrote about her experience with Hemiplegic Migraine, and it all clicked. It was like reading about myself. I recognized the symptoms. This is what I had. It had a name. Six months later, a headache specialist confirmed my hunch: I had Hemiplegic Migraine.

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Types Of Hemiplegic Migraines

There are two types of hemiplegic migraines, familial and sporadic. While the symptoms are the same, the types are characterized by the genetic component and incidence among family members. The diagnosis of type comes after the initial diagnosis of the migraine itself.

Familial hemiplegic migraine This is based solely on family history. If another family member has been diagnosed with a hemiplegic migraine, then others in the family who are diagnosed later with the same thing will be typed as familial.

Sporadic hemiplegic migraine When a person is diagnosed with hemiplegic migraine, yet there is not family history, they are typed as sporadic. However, if any family members are later diagnosed with hemiplegic migraine, those family members will be typed familial. The patient diagnosed with sporadic hemiplegic migraine will retain their original diagnosis.

Organizations For Resources And Help With Migraines

Familial Hemiplegic Migraine Explained

GARD: Genetic and Rare Disease Information Center . Hemiplegic Migraine. Retrieved April 25, 2017, from https://rarediseases.info.nih.gov/diseases/10768/hemiplegic-migraine

HEYCK, H. . VARIETIES OF HEMIPLEGIC MIGRAINE. Retrieved April 25, 2017, from http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.1973.hed1204135.x/full

Jen, J. C. . Familial Hemiplegic Migraine. Retrieved April 25, 2017, from https://www.ncbi.nlm.nih.gov/books/NBK1388/#fhm.Clinical_Description

Migraine Surgery | Migraine Doctors. . Retrieved April 25, 2017, from http://www.themigrainereliefcenter.com/

Optics, A. . Reviewed: Top 5 Migraine Tracking Apps. Retrieved April 25, 2017, from https://www.axonoptics.com/top-5-migraine-tracking-apps/

Robertson, MD, C.E. . Hemiplegic Migraine. Retrieved April 25, 2017, from https://www.uptodate.com/contents/hemiplegic-migraine

Team, J. W. . Accommodation and Compliance Series: Employees with Migraine Headaches. Retrieved April 25, 2017, from http://askjan.org/media/Migraine.html

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Treatment For Hemiplegic Migraine

Treatment of hemiplegic migraine can be challenging. The care of a headache specialist is often required, as many other doctors may never have treated a case of hemiplegic migraine.

Acute Hemiplegic Migraine Treatment

Triptans and ergotamines are currently contraindicated in the treatment of hemiplegic migraine because of their vasoconstrictive properties and concerns about stroke. One small study was conducted, safely using triptans with patients with hemiplegic migraine, but more trials are needed before theyre considered a safe option. Other treatments such as NSAIDs, antiemetics, and sometimes narcotic analgesics are used for symptomatic relief of hemiplegic migraine. Intranasal ketamine has been shown to shorten the duration of aura symptoms in patients with hemiplegic migraine.

Preventive Hemiplegic Migraine Treatment

Ichd Classification And Diagnosis Of Migraine

The classification of all headaches, including migraines, is organized by the International Headache Society, and published in the International Classification of Headache Disorders . The current version, the ICHD-3 beta, was published in 2013.

The first category within the ICHD is Migraine. Migraines in general are considered to be a neurological syndrome. It is estimated that 11% of the global population, including 43 million Europeans and 28 million Americans, experience migraines.

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Data Processing And Statistical Analysis

All data were processed and statistical analyses were performed using SPSS Base System 10.0 for Windows 98. The 2 test, MannWhitney test, KruskalWallis test, t test for independent samples and 95% confidence intervals were used as appropriate depending on the type of data. A 0.05 level of significance was used in single tests. When testing for multiple symptoms, a 0.001 level of significance was chosen in order to compensate for mass significance.

Ive Already Tried Everything What Else Can Be Done To Help My Hemiplegic Migraine

Instagram post by IHMF ⢠Mar 3, 2020 at 8:06pm UTC

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 child of the painful attacks. In some cases, these ways can alleviate the symptoms of Hemiplegic Migraine, however despite all of these treatment options, sufferers may still find themselves having painful attacks.

At the Brisbane 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.

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Treatments Look A Lot Like Traditional Migraine Treatments

I was already on a treatment plan for Chronic Migraine when I was diagnosed with Hemiplegic Migraine. I was surprised how little the plan changed with the diagnosis.

Preventative medication for hemiplegic migraine may be used to help prevent attacks. The new class of drugs colloquially has proven useful to many, while others dont see a significant change. Some find relief from hemiplegic migraine with medication such as Topamax and Gabapentin. My preventative medications did not change when I was diagnosed with Hemiplegic Migraine.

Differences in how abortive medication is used for hemiplegic migraine

Abortive medication, however, are used a bit differently in patients with Hemiplegic Migraine. Patients are generally not prescribed triptan or ergotamine medications due to concerns about stroke. However, there is emerging research that the risk of stroke is not increased with these medications. So some individuals are prescribed these medications as well. You and your doctor work together to determine the right treatment for your unique circumstances and case, so never discontinue a medication without checking with your doctor first. Two new CGRP medications Ubrelvy and Nurtec have been approved for use to abort a migraine attack, and many with Hemiplegic Migraine have found them useful. Nurtec helps slow down my Hemiplegic Migraine attacks, ultimately making them milder and shorter


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