Hemiplegic Migraine: What to Know About This Rare Headache That Can Mimic a Stroke

A hemiplegic migraine is a very rare type of migraine. About 1 in 3 people who get migraines develop auras, like vision changes. But people with hemiplegic migraines have a very unique aura pattern. They develop weakness or even paralysis on one side of their body along with other types of aura like vision changes and trouble speaking. 

If you’ve recently been diagnosed with hemiplegic migraines, here’s what you need to know about this rare condition. 

How is a hemiplegic migraine different from a regular migraine?

Classic migraines and hemiplegic migraines both cause severe headaches. But they are different in three important ways.

1. They have different types of auras

Many people have auras with their migraines. These auras usually start before the headache and give people an important clue that they’re about to have a migraine. 

Auras are sensory experiences that are different from person to person. People with classic migraines experience only one type of aura at a time. Some people experience vision changes, while others notice dizziness. Other people feel tingling sensations and some notice unusual smells. But people rarely experience motor auras that cause weakness or even paralysis on one side of the body. 

People who experience hemiplegic migraines experience more than one aura at a time. One of these auras is always a motor aura. In addition to the motor aura, they also experience other types of auras — like vision changes, numbness, slurred speech, or trouble balancing. 

2. Classic migraines are common, but hemiplegic migraines are rare

Classic migraines are pretty common. About 10% to 15% of people experience classic migraines. 

Hemiplegic migraines, on the other hand, are very rare. Scientists can’t even estimate how common they are because so few people experience them. One study from Denmark estimated that 0.01% of people have hemiplegic migraines. 

That means classic migraines are 1,000 times more common than hemiplegic migraines. 

3. Hemiplegic migraines are definitely hereditary

People are more likely to develop classic migraines if they have a family member who also has migraines. It’s likely that genes play a role in whether people develop classic migraines. But researchers haven’t found a definitive genetic link yet. 

But scientists have discovered the genes that cause hemiplegic migraines. They also know how these genes pass from one generation to the next. Nearly everyone with hemiplegic migraines has a family member with hemiplegic migraines. 

What are the symptoms of a hemiplegic migraine? 

Symptoms of a hemiplegic migraine include:

• Headache: People almost always develop a headache with a hemiplegic migraine. The headache usually starts after the auras. 

• Motor aura: People develop weakness or paralysis on one side of the body. This takes about 20 to 30 minutes to set in and can last for several hours. In about 5% of people, motor auras can last longer than a day.

• Second aura: The second type of aura can be different for each person. People commonly report vision changes, ear ringing, vertigo, or trouble keeping their balance.

Most people experience three episodes per year. The good news is that as people get older, they have fewer episodes and their auras go away. They may still experience headaches, but they won’t have other symptoms like paralysis or vision changes. 

When should you go to the emergency room for hemiplegic migraines?

If you or a loved one ever develops weakness on one side of your body, go to the emergency room right away. 

Sudden weakness, slurred speech, and trouble balancing are symptoms of a hemiplegic migraine. But these are the same symptoms people experience when they’re having a stroke. 

Hemiplegic migraines are very rare, it’s much more likely these symptoms are from another cause, like a stroke. Strokes are life-threatening conditions that need immediate treatment. 

If you have a history of classic migraines and develop one-sided weakness, go to the emergency room. Classic migraines don’t turn into hemiplegic migraines. And people don’t typically develop motor auras all of a sudden. So you still want to make sure your symptoms aren’t from a stroke.

If you already have a diagnosis of hemiplegic migraines, you may still need to go to the emergency room if you have an episode. Many people need medical support during their motor auras, especially if they experience paralysis for several hours. And even if you have hemiplegic migraines, you can still develop a stroke. So it’s always best to be safe and seek care. 

What are the treatments for hemiplegic migraines?

Hemiplegic migraines are rare, so studies that look at treatment options only have a handful of participants. When studies are this small, it’s impossible to know whether treatments that helped one person will work for someone else. 

So while treatments have helped some people, they may not work for you. You may need to try several medications and doses until you find the right one for you. The goal of medication treatment is to decrease (or even stop) your migraine episodes.

Medications that have helped people with hemiplegic migraines include:

• Verapamil 

• Topiramate

• Amitriptyline 

• Acetazolamide 

• Lamotrigine 

• Intranasal ketamine

• OnabotulinumtoxinA injections 

In general, experts recommend that you avoid medications that treat classic migraines — like triptans, beta blockers, and ergot derivatives — because they can constrict blood vessels and increase your risk of developing a stroke. 

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Written by:

Ashely Alker, MD, MSc

Ashely Alker, MD, MSc is an emergency medicine physician and nationally published writer and speaker who focuses on patient education through media and healthcare policy.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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