Hemiplegic Migraine: How Symptoms of This Rare Headache Can Seem Like 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 symptoms like weakness — or even paralysis — on one side of their body, along with other types of auras 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. 

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. 

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

• Vision and hearing changes: People commonly report vision changes, ear ringing, vertigo, or balance problems. These are called secondary auras.

Most people experience three episodes per year. The good news is that these episodes often become less frequent as people get older. They may still experience headaches, but they won’t have other symptoms like paralysis or vision changes. 

How is a hemiplegic migraine different from a regular migraine?

Both classic migraines and hemiplegic migraines cause severe headaches. But they’re different in three important ways.

1. They have different types of auras

Many people have auras with their migraines. Auras usually start before the headache and act as a warning sign of an oncoming migraine. 

Auras are sensory experiences that are different from person to person. People with classic migraines usually have only one kind of aura at a time. This could be vision changes, dizziness, tingling sensations, or even smelling something unusual. It’s rare for people with classic migraines to have motor auras that cause weakness or even paralysis on one side of the body. 

People who experience hemiplegic migraines have more than one aura at the same time. One of them is always a motor aura, which causes weakness and paralysis. Along with the motor aura, they also have 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 have them. 

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Hemiplegic migraines, on the other hand, are very rare. They’re so rare that scientists can’t even estimate how common they are. One study from Denmark estimated that only 0.01% of people have hemiplegic migraines. 

That means classic migraines are about 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, but researchers haven’t found a clear link yet. 

With hemiplegic migraines, the genetic link is much stronger. Scientists have found the genes that cause them. They also know how these genes pass from one generation to the next. Nearly everyone with hemiplegic migraines has a family member who has them too. 

What causes hemiplegic migraines?

Changes in certain genes seem to increase a person’s risk of developing hemiplegic migraines. There are two main types of hemiplegic migraines, and each is tied to different genetic changes.

Familial hemiplegic migraines

Familial hemiplegic migraines are hemiplegic migraines that run in families. Most people with this type of hemiplegic migraines have changes in these genes:

• People with familial hemiplegic migraine type 1 have changes in the CACNA1A gene.

• People with familial hemiplegic migraine type 2 have changes in the ATP1A2 gene.

• People with familial hemiplegic migraine type 3 have changes in the SCN1A gene.

All three genes affect how your body moves in response to signals from your brain. Changes in these genes pass from parents to their children. A child has a 50% chance of inheriting one of these gene changes if a parent has hemiplegic migraines. But not everyone who inherits these changes will develop hemiplegic migraines.

Scientists are still discovering other genes that can lead to hemiplegic migraines in families.

Sporadic hemiplegic migraines

Sporadic hemiplegic migraines are hemiplegic migraines that don’t run in families. People with this type are the first in their family to have symptoms. 

The same gene changes that cause familial hemiplegic migraines can also lead to sporadic hemiplegic migraines. Other gene changes can also lead to these migraines.

What can trigger hemiplegic migraines?

Most people with hemiplegic migraine don’t often have triggers for their migraine symptoms. This makes it harder for people to manage their attacks since they can’t always take steps to prevent them.

But in some studies, people with hemiplegic migraines reported that some things seemed to trigger symptoms. Possible hemiplegic migraine triggers include:

• Bright lights

• Lack of sleep

• Too much sleep

• Stress

• Intense activity or exercise

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. Hemiplegic migraines are very rare. It’s much more likely that the weakness is caused by something else — like a stroke. 

Strokes are life-threatening and 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. People don’t typically start having motor auras all of a sudden. It’s important to make sure your symptoms aren’t from a stroke.

You should also seek medical care right away if you develop:

• Sudden weakness

• Slurred speech

• Trouble balancing

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 when they have 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 hard to know whether treatments that helped one person will always work for others. 

So, while treatments have helped some people, they may not work for you. You may need to try different medications or doses to find what works best 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

In general, experts recommend avoiding medications that treat classic migraines. These include triptans, beta blockers, and ergot derivatives. These medications constrict (narrow) 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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