Quick Answer
Hemiplegic migraine causes temporary one-sided weakness — mimicking stroke. It's a migraine variant, but stroke must always be excluded first.
Medically reviewed by Dr. Jitendra Prasad Yadav • NMC 8029 • Kathmandu Neurology Clinic & Cognitive Center
Hemiplegic migraine is a rare migraine variant characterized by migraine headache accompanied by temporary motor weakness (hemiplegia) on one side of the body — often mimicking stroke. There are two types: familial hemiplegic migraine (FHM, genetic — CACNA1A, ATP1A2, SCN1A mutations) and sporadic hemiplegic migraine (SHM, no family history).
Symptoms
Migraine headache with aura including motor weakness (hemiplegia) — typically lasting minutes to hours but sometimes up to days. Aura may include visual disturbances, sensory changes, speech difficulty, confusion, and even coma (rare). Motor weakness is usually on one side but can be bilateral. Headache may precede, accompany or follow the aura.
Diagnosis
Clinical diagnosis after excluding stroke and other causes. MRI/MRA excludes structural causes. Genetic testing for FHM (CACNA1A most common). Family history of similar attacks supports FHM diagnosis. Misdiagnosis as stroke or epilepsy is common — accurate diagnosis prevents unnecessary treatments.
Treatment
Acute attacks: NSAIDs, antiemetics; avoid triptans and ergotamines in FHM (may worsen symptoms — controversial). Preventive: verapamil, acetazolamide, flunarizine, topiramate. For severe attacks: intravenous magnesium, valproate, or corticosteroids. Genetic counseling for FHM families.
When to seek professional evaluation
Hemiplegic migraine must be distinguished from stroke — because treatment differs and misdiagnosis is common.
This guide is educational and does not replace individual medical advice.
Migraine vs Other Headaches — Quick Comparison
| Feature | Migraine | Tension-Type |
|---|---|---|
| Pain | Throbbing, often one-sided | Pressure, band-like, bilateral |
| Severity | Moderate–severe | Mild–moderate |
| Other | Nausea, photophobia, aura | No nausea/vomiting, mild photophobia only |
Table for comprehension — see Migraine guide → for full criteria.
Frequently asked questions
Answers reviewed by Dr. Jitendra Prasad Yadav • MBBS, MD (Internal Medicine), FICN (Neurology), FCNV, FIHM • NMC 8029
Migraine is a neurological condition; headache is one feature. Associated symptoms and functional impact are important for diagnosis.
Aura refers to visual, sensory, or speech symptoms that precede the headache in some people. Both types are migraine; the presence of aura may influence management discussion.
Frequency may improve with systematic evaluation of types, contributors, and individualized planning, but outcomes vary.
Using pain medication on 10+ days per month can trigger daily headache. Reduction or cessation under medical supervision may help break this cycle.
Migraine typically presents as moderate-severe throbbing headache with nausea and/or sensitivity to light or sound, worsened by routine activity. Duration 4–72 hours. Dr. Jitendra Prasad Yadav (NMC 8029) uses ICHD-3 criteria plus your headache diary (frequency, aura, medication days) and red-flag screen to distinguish …
Prevention is discussed after 4–8 weeks of diary shows ≥8 migrainous days/month or medication-overuse pattern. Options include lifestyle regularity, comorbidity treatment and preventive medicines selected per history and contraindications. No preventive works instantly; follow-up with the same consultant tracks days/mo…
More: All FAQs → · Ask Dr. Jitendra →
Related articles
Understanding Migraine Triggers: What to Track and How
Learn how to identify personal migraine triggers, use a headache diary effectively, and discuss patterns with your clinician.
Migraine vs Ordinary Headache: How to Tell the Difference
Migraine is more than a strong headache —— timing, associated symptoms, and disability distinguish it from tension-type and cluster headache.
Menopause and Migraine: How Hormonal Changes Affect Headache — Kathmandu Guide
Menopause transforms migraine patterns — some women improve, others worsen. Learn the hormonal mechanisms and management options in Kathmandu.
Medical Disclaimer
Content on this website is for general educational purposes only and does not constitute medical advice, diagnosis, or treatment. It is not a substitute for evaluation by a qualified healthcare professional. Always seek the advice of your physician or other qualified provider with any questions regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you have read on this website. In case of a medical emergency, contact emergency services immediately. No doctor–patient relationship is established by use of this site or by contacting the clinic through the site.
References & Review
Reviewed by Dr. Jitendra Prasad Yadav • Last reviewed: 2026-11-10
- International Classification of Headache Disorders, 3rd edition (ICHD-3).
- Harrison's Principles of Internal Medicine — Neurology sections.
- American Academy of Neurology guidelines for selected conditions (where applicable).
Content is educational and aligns with standard medical references; individual evaluation may vary. External links provide context and do not imply endorsement.