A migraine symptom that needs careful attention
Hemiplegic migraine is a rare form of migraine with aura that includes temporary weakness on one side of the body. People may also have visual changes, tingling or numbness, trouble finding words, dizziness, or a migraine headache. The weakness can be alarming because it may look like a stroke.
Treat new weakness as an emergency
A prior migraine diagnosis does not make a new episode automatically safe. Call 911 for sudden weakness, facial drooping, trouble speaking, loss of vision, severe imbalance, or a sudden severe headache, especially if the symptoms are new, different, or more intense than usual. Stroke treatment is time-sensitive. Do not wait at home to see whether the symptoms pass.
How clinicians evaluate it
The diagnosis depends on the pattern of symptoms, the timing of the aura, examination findings, and medical and family history. Imaging or other testing may be needed to rule out stroke and other causes, particularly with a first episode or a major change in the usual pattern. Some forms run in families; others occur in one person without a known family history. Genetic testing is considered selectively and does not replace a clinical evaluation.
Treatment is individualized
Care may include an acute plan for attacks and preventive treatment when episodes are frequent or disruptive. Medication choices depend on the person’s symptoms, health history, and other medicines. Evidence for some treatments in hemiplegic migraine is limited, so a clinician should guide the plan. Do not start, stop, or change migraine medicine on your own.
When to arrange follow-up
After urgent causes have been addressed, follow up with a clinician if attacks recur, change, or interfere with daily life. A symptom diary that records the start and duration of weakness, other aura symptoms, headache, medicines, and recovery can help guide the visit.
Care from Neuro On Call
Neuro On Call offers virtual neurological evaluations for eligible patients age 14 and older in Texas, Arizona, Nevada, California, North Carolina, and Alaska. A virtual visit can help review a migraine history and discuss a care plan. It cannot replace emergency assessment for possible stroke symptoms. Visit www.neurooncall.org/scheduling to learn about appointments.
This article is for general education and does not replace personalized medical advice, diagnosis, or treatment. Call 911 for a medical emergency.
