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All About Hemiplegic Migraine Headaches

When Migraine Symptoms Resemble a Stroke

By Betsy Lee-Frye

Updated February 15, 2009

(LifeWire) - Migraine headaches are always painful and disruptive, but on rare occasions, the symptoms preceding a migraine can be downright terrifying. These symptoms resemble those of stroke, and may include dizziness, loss of motor control and one-sided paralysis.

Such headaches are termed "hemiplegic headaches": Hemi-, for half (as in hemisphere), and -plegic, for paralysis (as in quadriplegic or paraplegic). Unlike typical migraine symptoms, these hemiplegic symptoms can persist for days or even weeks.

The good news: There are treatments for these symptoms and strategies to help avoid them.

Overview of Hemiplegic Headaches

Hemiplegic headaches are a severe form of migraine with aura. An aura is a brain dysfunction that sometimes precedes a migraine headache, and may possibly involve chemical imbalances in the part of the brain responsible for vision.

If someone experiences migraine with aura, the aura usually occurs 5 to 90 minutes before the onset of the headache. In rare cases, the aura can continue through the duration of the headache. Auras typically involve visual disruptions, such as flashing lights or areas of diminished vision.

With hemiplegic migraines, the aura is much more severe and can cause temporary paralysis or numbness on one side of the body, or a loss of motor control. Individuals who have experienced a hemiplegic headache say they also endured dizziness, visual disturbances, involuntary eye movement, attention deficits and memory loss.

In very rare cases, hemiplegic headaches appear to cause damage to the brain. This phenomenon is not completely understood, but some studies link hemiplegic headaches to stroke and recurrent coma. Studies indicate that the more intense and frequent the hemiplegic migraines, the more likely the individual will suffer serious consequences.

Types of Hemiplegic Migraines

Such headaches can be divided into two types: Familial and sporadic.

As the name suggests, the familial form is inherited. Researchers have identified three different gene mutations that are associated with familial hemiplegic migraines. The key to a familial hemiplegic migraine diagnosis is having a first-degree relative, such as a parent, sibling or child, who also experiences such headaches.

Symptoms of sporadic hemiplegic headaches are identical to those of familial headaches but involve no family history of the illness.

The average onset of hemiplegic headaches occurs around the age of 17, but can vary widely from 1 to 45 years of age, depending on the individual. The good news is that headache frequency and intensity tend to decrease over time.

There are no concrete figures on how common these headaches are. One study estimates that only 1 in every 10,000 individuals experiences familial hemiplegic headaches. Sporadic hemiplegic migraines are even less common -- affecting approximately 1 in every 20,000 individuals.

Gene Mutations Matter

Understanding the familial type of hemiplegic headaches involves knowing something about the specific gene mutations at work. It is easiest to refer to these three mutations simply as type 1, type 2 and type 3. Researchers are studying these mutations to determine the cause of hemiplegic headaches as well as more effective treatment options.

Individuals with type 1 mutations, which account for almost half of all familial hemiplegic headache cases, have a 90% chance of experiencing a loss of motor control during a hemiplegic headache. In addition, those with type 1 mutations may experience cerebral degeneration. This refers to the deterioration and death of cells in the cerebellum, the area of the brain responsible for motor control.

Type 2 and type 3 mutations are much less common and are associated with recurrent seizures.

Because symptoms are so closely linked with family history, experts recommend genetic counseling for those with familial hemiplegic migraines. Studies show that if one parent is affected, their children will have a 1 in 2 chance of inheriting the condition.

Prenatal testing is available through custom laboratories.

Treatment Options

Researchers are exploring a variety of treatment options both familial and sporadic hemiplegic migraines.

In one recent study, researchers treated patients with triptans, a class of drugs commonly used in treating migraine and cluster headaches. The study found that use of triptans yielded significant improvements among those with hemiplegic headaches.

In addition, Calan (verapamil) -- also known as Covera-HS, Isoptin SR and Veralan -- can be used to treat hemiplegic headaches with demonstrated success. This drug is typically used to treat high blood pressure and irregular heart rhythms.

Diamox Sequels (acetazolamide) -- a medication variously used to treat glaucoma, altitude sickness and epilepsy -- has also shown promise as a treatment regimen.

However, most physicians still treat hemiplegic headaches with typical migraine medications, including Motrin or Advil (ibuprofen), and beta-blockers or calcium channel blockers, both of which are commonly used to treat high blood pressure.

Medications that constrict the arteries and veins should not be used in treating hemiplegic headaches, because they may increase the risk of stroke. All medications -- including dietary supplements and herbal remedies -- carry potential side effects and risks, so talk to a doctor before beginning a treatment regimen.

"An ounce of prevention is worth a pound of cure": It is an old adage, but as true for these headaches as for any other form of migraine. Keeping a headache diary, a written record of your migraine symptoms, can help determine your triggers, increasing your ability to avoid headaches and lessening your need to rely on medication.

However, if you do experience a hemiplegic headache, it is imperative that you see a physician in order to rule out other serious conditions, like stroke or vascular disease, which may produce similar symptoms.

Sources: Artto, V., M. Nissila, M. Wessman, A. Palotie, M. Farkkila, and M. Kallela. "Treatment of Hemiplegic Migraine With Triptans." European Journal of Neurology. 14. 9. Sep. 2007. 1053-1056. <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1468-1331.2007.01900.x>. (subscription)

Cha, Y-H, D. Millett, M. Kane, J. Jen, R. Baloh. "Adult-onset hemiplegic migraine with cortical enhancement and oedema." Cephalalgia. 27.10. Oct. 2007. 1166-1170. <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1468-2982.2007.01369.x>. (subscription)

Gardner, Kathy Lou. " Familial Hemiplegic Migraine." Geneclinics.org. 4 Jan. 2007. Gene Reviews. 1 Apr. 2008. <www.geneclinics.org/profiles/fhm/index.html>.

Gargus, J.J.,  and A. Tournay. "Novel Mutation Confirms Seizure Locus SCN1A is Also Familial Hemiplegic Migraine Locus FHM3." Pediatric Neurology 37.6. Dec. 2007. 407-410. <http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TBD-4R4VVPK-6&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2e31ca8a1a079d591eabace0a295c9c1>. (subscription)

Thomsen, L.L., and J. Olesen. "Sporadic Hemiplegic Migraine." Cephalalgia. 24.12. Dec. 2004. 1016-1023. <http://www.blackwell-synergy.com/doi/abs/10.1111/j.1468-2982.2004.00788.x >.

Weinberger, J.. "Interactions Between Migraine and Stroke." Current Treatment Options in Neurology. 8.6. Nov. 2006. 513-517. <http://www.treatment-options.com/cr_linkout_frmst.cfm?issn=1092-8480&vol=8&page=513>. (subscription)

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Betsy Lee-Frye is an independent journalist based in Kansas City, Mo. Her work has appeared in the Dallas Morning News, Better Homes and Gardens Special Interest Publications and the St. Joseph News-Press.
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