Hemiplegic Migraine: Symptoms and Treatments

Learn more about this rare type of migraine, its different forms and why it’s important to get an accurate diagnosis and proper treatment.

Hemiplegic migraine is a rare form of migraine where people experience weakness on one side of their body (hemiplegia) along with headache and other symptoms that are often the same as seen in migraine. The weakness is a form of migraine aura and occurs with other typical migraine aura signs like changes in vision, speech or sensation.

There are two types of hemiplegic migraine: Familial hemiplegic migraine (runs in the family) and sporadic hemiplegic migraine (occurs only in one person with no family history). Be aware that this is an extremely rare migraine type. If you ever develop weakness with your headache, you should seek immediate medical attention and not make assumptions about your condition.

Symptoms of Hemiplegic Migraine

Both familial and sporadic hemiplegic migraine often begin in childhood. The symptoms can last for hours to days or even weeks in rare cases, but most will go away completely.

Primary symptoms include:

  • Weakness on one side of the body (hemiplegia)
  • Headache
  • Other typical aura symptoms, such as vision changes, numbness, tingling and trouble speaking

A person may also experience:

  • Fever
  • Changes in consciousness, from confusion to profound coma
  • Problems with coordination
  • Nausea or vomiting
  • Increased sensitivity to sound and light

Because the symptoms of hemiplegic migraine are similar to stroke, seizures or other potentially serious neurological conditions, it’s important to see a doctor to receive a clear diagnosis. During this visit, a doctor will carefully review your medical history and do a complete neurological exam. They may also order scans to look at your brain and the blood vessels in your head. These steps are necessary to rule out other causes and confirm a diagnosis. Because hemiplegic migraine often runs in the family, the doctor will likely ask you about your family medical history, especially any history of headache or migraine.

Being prepared is key to having a productive conversation with your healthcare provider. Download our free guide for more advice and tips about talking to your doctor about migraine.

Hemiplegic Migraine Treatment Options

Once you have a diagnosis, it’s important to talk about migraine management with your doctor. Hemiplegic migraine is very rare. So you might get a referral to a headache specialist or doctor who has experience treating this type of migraine. Then, they can put together a treatment plan that works for your lifestyle and goals.

Your doctor may prescribe acute (short-acting) treatments like NSAIDs or medications to reduce nausea. Intranasal ketamine (a medication taken through the nose) may shorten aura. Triptans and ergotamines are currently not recommended for treatment because they constrict blood vessels and increase the risk of stroke. However, a newer class of medications—the detans—don’t work this way and may be prescribed by your doctor.

Given how severe the symptoms can be and how certain medications interact, most patients and providers use preventive treatment to manage hemiplegic migraine. Because hemiplegic migraine is related to migraine with aura, certain preventive medications commonly used to treat typical migraine with aura may be helpful. Preventive treatment can include daily medications, supplements or lifestyle changes and should be discussed with your healthcare provider.

FAQ About Hemiplegic Migraine

How rare is hemiplegic migraine? Who is affected?

While migraine affects 1 billion people worldwide, hemiplegic migraine occurs in 0.01% of those cases. Women are three times more likely to have the condition than men. The average age of onset is 12 to 17 years old.

What are common triggers for hemiplegic migraine ?

Like other types of migraine, hemiplegic migraine has various triggers, and it’s not always possible to identify what causes an attack. Common triggers include certain foods or smells, lights, stress, too little or too much sleep, physical activity and head trauma. While trigger management helps, it’s important to remember that some attacks occur randomly. Allow yourself to rest if an unexpected attack occurs.

Why is proper diagnosis especially important?

Symptoms of hemiplegic migraine are also symptoms of other severe medical conditions like stroke and epilepsy. Proper diagnosis is critical with this form of migraine to get the right care and treatment. To rule out other causes, people experiencing these symptoms will likely need imaging studies and additional testing.

With continuing research, especially genetic research, we are learning more about hemiplegic migraine. As this research continues, we will better understand, diagnose, treat and prevent hemiplegic migraine.

The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine, visit the AMF Resource Library. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.

Reviewed for accuracy by the American Migraine Foundation’s subject matter experts, headache specialists and medical advisers with deep knowledge and training in headache medicine. Click here to read about our editorial board members.