Sporadic Hemiplegic Migraine - Diagnosing and Treating

The road to a proper diagnosis of Sporadic Hemiplegic Migraine (SHM) can be a long one, because there are so many other things that must be ruled out before you can be sure.  But it's so important to get to that point, and get the treatment you need.  The process is not always easy, but it's a process that's important to walk through.  SHM can at times look like stroke, epilepsy, meningitis, other types of migraine, and other conditions.

SHM can strike both men and women (though it more often strikes women), and often starts in childhood.  Sometimes people are so concerned about their symptoms they're afraid to go to the doctor, and they miss out on the helpful treatment that is available.

Thankfully, SHM is believed to be fairly rare - striking 0.01% of the population or less.  But that's not much comfort if you have it!

Do I have Sporadic Hemiplegic Migraine?

Sporadic Hemiplegic Migraine- has one side of my body gone crazy?! Picture © Darknightsky | Dreamstime.com

First of all, we're talking about a type of "migraine with aura".  That means you're experiencing migraine attacks that include certain non-headache symptoms.  The headache (if there is one) comes during these symptoms or within an hour of them.

What kinds of symptoms come along with sporadic hemiplegic migraine?  First, the tell-tale one - "motor weakness".  That means your muscles feel weak, even to the point of feeling paralyzed.  In fact, it can be difficult to walk during this stage of your migraine attack.

Because of the strange symptoms of hemiplegic migraine, it's sometimes confused with basilar-type migraine.  Motor weakness differentiates the two - if you have motor weakness, it's not basilar type migraine.

The paralysis is almost always one-sided, hence the confusion with stroke.  Sometimes the upper limbs will be weaker.

Also, you'll experience at least one of these aura symptoms:

• Visual aura (ie seeing flickering lights, spots, or actual loss of vision)
• Sensory aura (such as a prickly feeling, pins and needles, or numbness)
• Speech disturbances - trouble understanding and using words (dysphasia)

Each of these symptoms will be temporary.  They may develop gradually over 5+ minutes, or may even come in succession.  They could last 5 minutes or up to 24 hours.  Though these are the typical time frames, sometimes the symptoms will last even longer - beyond even the "headache" stage.  It's not uncommon to experience all the symptoms.

The headache, if there is one, can last from a few hours to 3 days untreated.  Sporadic hemiplegic migraine headache has the characteristics of a migraine headache, meaning it has at least two of these characteristics: one-sided, pulsating/throbbing, moderate to severe pain, and aggravated by activity.  Migraine pain also typically causes nausea and/or sensitivity to light or sound.

Other symptoms are sometimes present, such as fever, lethargy, imbalance, confusion, even a loss of consciousness.

Since there are two kinds of hemiplegic migraine, there's one more differentiation.  If a close relative (first or second degree) has the same condition, then you'll be diagnosed with familial hemiplegic migraine.  FHM more often has certain genetic markers.  Recent research has shown us that some cases of SHM have the same markers, but it's classified separately.

Ruling out other conditions

It's critical to rule out other medical conditions, because sporadic hemiplegic migraine can mimic so many other things.  If you visit a doctor for the first time, and without any tests or background you're told you have this type of migraine, you need a second opinion.

Here are some of the things your doctor or specialist may do if you have these symptoms:

• Take down a full medical history, including asking you questions about your family medical history (both very important!).
• Give you a general physical examination (including blood tests)
• Give you a neurological examination
• Magnetic resonance imaging (MRI)
• Electroencephalography (EEG)
• Lumbar puncture (spinal tap)
• Magnetic resonance angiography (MRA)
• Computed tomography (CT) scan
• other

Sporadic Hemiplegic Migraine Treatment

There are special concerns when it comes to sporadic hemiplegic migraine that aren't present in every type of migraine.  First, there is some concern that SHM may lead to other medical conditions down the road.

Just how "degenerative" migraine is is a controversial topic.  However, because of the concern that SHM may increase your risk of stroke and neurological conditions down the road, even more so than other types of migraine, your doctor may be more likely to recommend a preventative medication.

Also, depending on your symptoms, there is a greater danger of injury due to the paralysis and other symptoms.  Because of this, your doctor will want to make sure you don't have an attack in the first place, rather than just minimize the attack when it comes.

Of course this will depend on your specific symptoms and the results of the tests and histories your doctor took.  For some, the symptoms may not be severe at all, and little medication may be needed.

• Abortive medications:  medications to stop or minimize symptoms once they start are still given, even if you're on preventatives.  Because of the concerns about stroke, certain common migraine drugs are avoided, such as the triptans and ergotamines.  (Recent studies have suggested that the triptans may be safe - again, this is controversial and more studies need to be done.  Talk to your doctor about the various risk factors specific to you before making a decision)  Commonly used are NSAIDs (non-steroidal anti-inflammatory drugs), and in some cases narcotics.
• Preventative medications:  There are various preventative drugs used, such as beta blockers, calcium channel blockers (such as verapamil), anti-convulsants, and others.
• Other:  As with all types of migraine, there are various other types of treatment which can be very successful.  This can include lifestyle changes, supplements such as magnesium, and biofeedback.

Sporadic Hemiplegic Migraine Prognosis

Though the road can be long to getting proper treatment for SHM, there is excellent treatment available.  You do need to be patient and go through the steps to make sure you're getting a proper diagnosis and the right treatment.

Because of the severity of some people's symptoms, it's also wise to be sure your family and friends are aware of your condition, even if it's under control.  Wearing a MedicAlert bracelet is a wise precaution once you're sure of your diagnosis.

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References:  What is Hemiplegic Migraine? from The Migraine Trust, reviewed February 2008; Sporadic hemiplegic migraine Thomsen LL, Olesen J. December 2004; Living Well With Migraine Disease and Headaches by Teri Robert, 2005; Sporadic Hemiplegic Migraine by Dr. David F. Black, 2004; Sporadic Hemiplegic Migraine: A Challenging Diagnosis, Azra Zafar, Shahid Mustafa, Kaneez Aelia (Dept of Neurology Liaqat National Hospital), 2006; Headache and Your Child by Dr Seymour Diamond and Amy Diamond, 2001; The International Classification of Headache Disorders 2nd Edition, International Headache Society, 2003; Migraine and other Headaches by Dr William B. Young and Dr Stephen D. Silberstein, 2004