Hemiplegic MigraineHemiplegic migraine is a rare type of headache. Symptoms may include weakness on one side of the body, to the point of paralysis. This may last less than an hour or as long as a week. At times, numbness on one side of the body, speech disturbance, unsteady gait (ataxia), visual aura (bright lights/flashing lights) or loss of consciousness can occur. Some patients even experience fever and a stiff neck (symptoms often associated with meningitis). The neurological symptoms are then followed by typical migraine symptoms such as a throbbing headache, nausea, vomiting, and sensitivity to light, sound, and smell. Patients may also report worsening of head pain with mild activity. Sometimes the weakness and other neurological symptoms are prominent while the following headache is milder, making the diagnosis more difficult. Hemiplegic migraine can sometimes be difficult to distinguish from basilar artery migraine. Basilar artery migraine, though, is not associated with weakness. Many cases of hemiplegic migraine are associated with a strong family history (a mother or father with similar symptoms) and specific genetic abnormalities have been identified in such (familial) cases. In many cases, though, there is no such family history (sporadic cases). In sporadic cases, minor head trauma may be a trigger specific episodes. The main concern, in the case of these headaches, is to make sure that a transient ischemic attack, a stroke, a seizure, or meningitis is not the cause of the symptoms. Thus patients with these symptoms (the first time they are experienced) require an emergent hospital evaluation. While hemiplegic migraine is typically diagnosed in childhood, it can occur for the first time at any age. TreatmentAny of the usual acute treatments for migraine may also be used in the case of this special type of migraine. There is controversy regarding the use of triptan medications (Imitrex, Maxalt, Zomig, Relpax, etc.), as there is concern that these could cause strokes in patients with this type of headache. While this has not in fact been proven to be the case, most neurologists avoid this class of medications for this reason. This same relative contraindication would apply to other vasoactive (artery constricting) drugs such as a class of medication called ergotamines.Verapamil, a calcium channel blocker, is the preventative medication of choice for this type of migraine. If this is not effective in reducing the frequency and intensity of headaches, then other standard preventative medications can be used. Beta-blocking medications (Inderal, propranolol, Corgard) are often avoided, as they may cause prolongation of auras and there has been concern that they could make migrainous infarction (a stroke associated with a migraine) more likely to occur. Return form Hemiplegic Migraine to Home
|
