First we have to understand that migraine attacks are episodic manifestations of a genetic neurological disease before we can understand hemiplegic migraine. A rare form of migraine disease, which can present in a variety of ways, hemiplegic migraine is more confusing by its being of two types: Sporadic Hemiplegic Migraine (SHM) and Familiar Hemiplegic Migraine (FHM).

Both SHM and FHM often start in childhood and cease during adult years. As the symptoms also pinpoint vascular disease and can be thought to be epilepsy, stroke, and other conditions, diagnosing both SHM and FHM can be difficult.

To confirm a diagnosis of SHM and FHM by ruling out other causes, a full neurological work up and careful review of medical history and symptoms are required. Family medical history is particularly very helpful in diagnosing FHM.

SHM and FHM Symptoms:

They are:

• Photophobia and/or phonophobia

• Fever

• Ataxia (defective muscle coordination)

• Episodes of prolonged aura (up to several days or weeks)

• Vomiting and/or nausea

• Headache, which may start before the hemiplegia or be absent

• Hemiplegia (paralysis on one side of the body)

• The onset of the hemiplegia may be sudden and may stimulate a stroke

• Impaired consciousness that range from confusion to profound coma

• Meningismus (accompanying inflammation, symptoms of meningitis without the actual illness)

Treatment Options for SHM and FHM:

They are:

Abortive and Pain Relief. NSAID’s, antiemetics, and narcotic analgesics are generally used for relief of hemiplegic migraine. It is important here to mention that migraine-specific abortives, the ergotamines and the triptans, are currently contraindicated in hemiplegic migraine treatments because of their vasoconstrictive properties and concerns about stroke.

Prevention. Preventive regimens are thought to be especially important in the treatment of hemiplegic migraine given the contraindication of abortive medications and the severity of the symptoms.