Q: My daughter has had hemiplegic migraines since she was 8. I am devastated for her as it is really debilitating. Do you have any suggestions?
A: Hemiplegic migraine is a rare form of migraine that is considered to be one of the more severe types. It is characterized by a fully reversible motor weakness, such as motor paralysis on one side of the body. This precedes the headache and totally resolves within 24 hours. It may be accompanied by numbness or a pins-and-needles sensation. The neurological symptoms usually leave when the headache appears.
The first step in management is a proper work-up to exclude other causes, including mitochondrial disorders that can mimic hemiplegic migraine. If possible, obtain genetic testing to confirm the diagnosis (hemiplegic migraine has a strong genetic component).
Once confirmed, treatment should consist of non-pharmacologic measures, such as dietary modification to avoid triggers, regular exercise and sleep, and dietary supplementation, such as magnesium. Topiramate, valproic acid and calcium channel blockers have shown the best pharmacologic results. Triptans must be avoided to prevent severe complications like stroke. This type of care is best provided under supervision of a multidisciplinary headache clinic or a specialized neurologist.
