A young college student sits crumpled in the floor of her dorm room. She is supposed to be in class, but cannot even bring herself to get dressed. She began experiencing visual field disturbances, nausea, and light sensitivity – all classic symptoms of migraine aura. But the symptoms quickly became more severe, causing confusion, slurred speech, and paralysis on one half of her body. Her roommate returns to find her experiencing stroke-like symptoms and calls for an ambulance. Hours later, she reveals something shocking: She has been experiencing these symptoms since childhood – all caused by a rare form of migraine known as hemiplegic migraine.
About Hemiplegic Migraines
Hemiplegic migraine attacks are a highly uncommon sub-type of migraines with aura. Though few people ever experience one of these migraine episodes, those who do typically suffer from a severely debilitating migraine symptom that can last for several days. For hemiplegic migraineurs, it is the aura phase that is so incapacitating. The term hemiplegic itself refers to paralysis on only half of the body. Doctors diagnose the condition based on the migraine symptom experienced during aura, which must include non-permanent motor weakness accompanied by visual disturbances, sensory disruptions or dysphasic speech disturbance.
It’s important to remember that each person will experience a hemiplegic migraine differently. Symptoms are not always consistent from episode to episode. While some people will experience similar symptoms with each attack, others will have migraines with aura symptoms and headache pain that vary in intensity and duration.
Due to the rarity of hemiplegic migraines and their symptoms, the condition can go mis-diagnosed or mistaken for other medical conditions, such as stroke or epilepsy. Furthermore, migraines – including hemiplegic migraines – often present during early childhood (usually between the ages of 5 and 8). Fortunately, many cases of hemiplegic migraines subside in adulthood.
What Researchers Know About Hemiplegic Migraines
Because hemiplegic migraines are rare, little is known about why they occur. In fact, they are so uncommon that headache researchers in Denmark attempting to study the condition found only 147 people with confirmed cases of familial hemiplegic migraines out of more than 27,000 cases of reported headache sufferers.
What doctors and scientists have been able to pinpoint from their research is two different types of hemiplegic migraineurs – those with Familial Hemiplegic Migraines (FHM) and those with Sporadic Hemiplegic Migraines (SHM). Though they share the same symptoms, people with FHM have a family history of the condition linked to specific genetic mutations. Less frequently, migraineurs will present with SHM, which is a hemiplegic migraine disorder devoid of known related genetic mutations.
Research is ongoing to learn more about how hemiplegic migraines respond to internal and external stimuli. According to the National Institute of Neurological Disorders and Stroke, the connection between FHM genetic mutations and hemiplegic migraines is believed to be associated with heightened levels of glutamate and dysfunctional calcium regulation in the brain.
The complexities of FHM and SHM make them difficult for doctors to treat. Because hemiplegic migraines are simply an expression of an underlying neurological disorder, researchers are tasked with learning how to not only reduce migraine frequency, but also to manage the severe symptoms of hemiplegic migraines. Non-steroidal anti-inflammatory drugs, antiemetics, and narcotic analgesics are most frequently used for pain relief, and calcium channel blockers are used to prevent hemiplegic migraine episodes.
Doctors are reluctant to prescribe traditional migraine pain relief medications like triptans and ergotamines to FHM and SHM patients because their properties raise concerns about vascoconstriction and stroke. However, a 2007 study of the safety and efficacy of triptans for FHM and SHM patients showed a migraine symptom reduction without instances of stroke or heart attack. Though additional research is needed, it seems that triptans could prove to be both a safe and effective hemiplegic migraine treatment.
Have you been diagnosed with hemiplegic migraines? Share your story in the comment section below.