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Hemiplegic Migraine

Two Rare Forms

Migraine is the most common of all neurological conditions that afflict mankind and manifests in a variety of ways. It is known that migraines have a definite genetic component and tend to run in families. Hemiplegic migraine is a rare form of migraine disease consisting of two variations: familial hemiplegic migraine (FHM) and sporadic hemiplegic migraine (SHM).

Copycat Symptoms

FHM and SHM tend to develop in childhood and cease during adulthood. Making the diagnosis is not an easy process since symptoms mimic those of vascular disease, stroke, epilepsy, and other conditions. The process is one of ruling out other diseases with similar symptoms along with taking a careful family medical history.

While both FHM and SHM share the same symptoms, FHM differs in that its origins can be traced back to the patient's family history and can be linked to mutations of certain genes on chromosomes 1 and 19. SHM has no familial connection and is not associated with these particular gene mutations.

Symptoms of FHM and SHM include:

- Ataxia-Poor muscle coordination
- Coma
- Confusion
- Fever
- Hemiplegia-One-sided paralysis
- Headache that begins before hemiplegia
- Meningismus-Symptoms that mimic meningitis
- Nausea and/or vomiting
- Prolonged aura-lasts for several days or even weeks
- Sensitivity to light and sound
- Sudden hemiplegia that mimics stroke

The treatment of hemiplegic migraines presents a challenge to the physician since there are a greater number of symptoms and these symptoms are more difficult to treat. A migraineur suffering from hemiplegic migraine would do well to study up on the disease and its treatment. Those with FHM and SHM should attempt to find a physician with experience in treating these specific types of migraine since many doctors have never encountered the hemiplegic forms of the disease.

Because there is a connection between stroke and hemiplegic migraine types, triptans and ergotamines, both migraine-specific abortives, are contraindicated for treating hemiplegic migraines, due to the vasoconstrictive properties of these drugs.  Other migraine treatments, including nonsteroidal anti-inflammatory drugs (NSAIDs), anti-nausea medications and narcotic analgesics can be used for relief of symptoms.

Because of the severity in the way hemiplegic migraines manifest, it is most important to institute a preventive regimen. Calcium channel blockers are often effective as a preventive therapy for FHM, since the mutation affects calcium channels and their ability to regulate the amount of calcium entering cells. This makes for hair-trigger neuron firing, leading to hemiplegic migraine attacks.

Those with FHM and SHM should carry medical identification at all times to ensure expedient and appropriate medical treatment in case of emergency, since they may not be able to speak during an attack.