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Hemiplegic migraine

INTRODUCTION

The hallmark of hemiplegic migraine is unilateral weakness that accompanies a migraine headache attack. The weakness is a manifestation of motor aura and occurs with other forms of aura that impair vision, speech, or sensation. This form of migraine with aura may occur either in families or only in one individual (sporadic).

This topic will review the pathophysiology, clinical features, diagnosis, and management of familial and sporadic hemiplegic migraine. Other aspects of migraine are discussed elsewhere. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults" and "Pathophysiology, clinical features, and diagnosis of migraine in children" and "Migraine with brainstem aura (basilar-type migraine)" and "Vestibular migraine".)

CLASSIFICATION

The primary feature that separates hemiplegic migraine from other types of migraine with aura is the presence of motor weakness as a manifestation of aura in at least some attacks. Migraine auras most often manifest as visual disturbances, but can also involve sensory, verbal, and rarely motor disturbances. Thus, hemiplegic migraine is an uncommon subtype of migraine with aura. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults", section on 'Migraine aura'.)

Hemiplegic migraine may be familial or sporadic, as discussed in the following section.

PATHOPHYSIOLOGY AND GENETICS

The weakness that characterizes hemiplegic migraine is a manifestation of motor aura. The aura of hemiplegic migraine is most probably caused by cortical spreading depression, a self-propagating wave of neuronal and glial depolarization that spreads across the cerebral cortex. (See "Pathophysiology, clinical manifestations, and diagnosis of migraine in adults", section on 'Cortical spreading depression'.)

                         

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Literature review current through: Aug 2014. | This topic last updated: Jul 1, 2014.
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References
Top
  1. Ophoff RA, Terwindt GM, Vergouwe MN, et al. Familial hemiplegic migraine and episodic ataxia type-2 are caused by mutations in the Ca2+ channel gene CACNL1A4. Cell 1996; 87:543.
  2. Terwindt GM, Ophoff RA, Haan J, et al. Variable clinical expression of mutations in the P/Q-type calcium channel gene in familial hemiplegic migraine. Dutch Migraine Genetics Research Group. Neurology 1998; 50:1105.
  3. Ducros A, Denier C, Joutel A, et al. The clinical spectrum of familial hemiplegic migraine associated with mutations in a neuronal calcium channel. N Engl J Med 2001; 345:17.
  4. Kors EE, Haan J, Giffin NJ, et al. Expanding the phenotypic spectrum of the CACNA1A gene T666M mutation: a description of 5 families with familial hemiplegic migraine. Arch Neurol 2003; 60:684.
  5. Jen JC, Kim GW, Dudding KA, Baloh RW. No mutations in CACNA1A and ATP1A2 in probands with common types of migraine. Arch Neurol 2004; 61:926.
  6. Russell MB, Ducros A. Sporadic and familial hemiplegic migraine: pathophysiological mechanisms, clinical characteristics, diagnosis, and management. Lancet Neurol 2011; 10:457.
  7. Thomsen LL, Kirchmann M, Bjornsson A, et al. The genetic spectrum of a population-based sample of familial hemiplegic migraine. Brain 2007; 130:346.
  8. Giffin NJ, Benton S, Goadsby PJ. Benign paroxysmal torticollis of infancy: four new cases and linkage to CACNA1A mutation. Dev Med Child Neurol 2002; 44:490.
  9. Alonso I, Barros J, Tuna A, et al. Phenotypes of spinocerebellar ataxia type 6 and familial hemiplegic migraine caused by a unique CACNA1A missense mutation in patients from a large family. Arch Neurol 2003; 60:610.
  10. De Fusco M, Marconi R, Silvestri L, et al. Haploinsufficiency of ATP1A2 encoding the Na+/K+ pump alpha2 subunit associated with familial hemiplegic migraine type 2. Nat Genet 2003; 33:192.
  11. Jurkat-Rott K, Freilinger T, Dreier JP, et al. Variability of familial hemiplegic migraine with novel A1A2 Na+/K+-ATPase variants. Neurology 2004; 62:1857.
  12. Bassi MT, Bresolin N, Tonelli A, et al. A novel mutation in the ATP1A2 gene causes alternating hemiplegia of childhood. J Med Genet 2004; 41:621.
  13. Ambrosini A, D'Onofrio M, Grieco GS, et al. Familial basilar migraine associated with a new mutation in the ATP1A2 gene. Neurology 2005; 65:1826.
  14. Vanmolkot KR, Kors EE, Hottenga JJ, et al. Novel mutations in the Na+, K+-ATPase pump gene ATP1A2 associated with familial hemiplegic migraine and benign familial infantile convulsions. Ann Neurol 2003; 54:360.
  15. Dichgans M, Freilinger T, Eckstein G, et al. Mutation in the neuronal voltage-gated sodium channel SCN1A in familial hemiplegic migraine. Lancet 2005; 366:371.
  16. Vanmolkot KR, Babini E, de Vries B, et al. The novel p.L1649Q mutation in the SCN1A epilepsy gene is associated with familial hemiplegic migraine: genetic and functional studies. Mutation in brief #957. Online. Hum Mutat 2007; 28:522.
  17. Castro MJ, Stam AH, Lemos C, et al. First mutation in the voltage-gated Nav1.1 subunit gene SCN1A with co-occurring familial hemiplegic migraine and epilepsy. Cephalalgia 2009; 29:308.
  18. Vahedi K, Depienne C, Le Fort D, et al. Elicited repetitive daily blindness: a new phenotype associated with hemiplegic migraine and SCN1A mutations. Neurology 2009; 72:1178.
  19. De Cunto A, Bensa M, Tonelli A. A case of familial hemiplegic migraine associated with a novel ATP1A2 gene mutation. Pediatr Neurol 2012; 47:133.
  20. Dale RC, Gardiner A, Antony J, Houlden H. Familial PRRT2 mutation with heterogeneous paroxysmal disorders including paroxysmal torticollis and hemiplegic migraine. Dev Med Child Neurol 2012; 54:958.
  21. Riant F, Roze E, Barbance C, et al. PRRT2 mutations cause hemiplegic migraine. Neurology 2012; 79:2122.
  22. Marini C, Conti V, Mei D, et al. PRRT2 mutations in familial infantile seizures, paroxysmal dyskinesia, and hemiplegic migraine. Neurology 2012; 79:2109.
  23. Cloarec R, Bruneau N, Rudolf G, et al. PRRT2 links infantile convulsions and paroxysmal dyskinesia with migraine. Neurology 2012; 79:2097.
  24. Lee HY, Huang Y, Bruneau N, et al. Mutations in the gene PRRT2 cause paroxysmal kinesigenic dyskinesia with infantile convulsions. Cell Rep 2012; 1:2.
  25. Stelzl U, Worm U, Lalowski M, et al. A human protein-protein interaction network: a resource for annotating the proteome. Cell 2005; 122:957.
  26. Jarvis SE, Zamponi GW. Masters or slaves? Vesicle release machinery and the regulation of presynaptic calcium channels. Cell Calcium 2005; 37:483.
  27. Suzuki M, Van Paesschen W, Stalmans I, et al. Defective membrane expression of the Na(+)-HCO(3)(-) cotransporter NBCe1 is associated with familial migraine. Proc Natl Acad Sci U S A 2010; 107:15963.
  28. Riant F, Ducros A, Ploton C, et al. De novo mutations in ATP1A2 and CACNA1A are frequent in early-onset sporadic hemiplegic migraine. Neurology 2010; 75:967.
  29. de Vries B, Freilinger T, Vanmolkot KR, et al. Systematic analysis of three FHM genes in 39 sporadic patients with hemiplegic migraine. Neurology 2007; 69:2170.
  30. Thomsen LL, Oestergaard E, Bjornsson A, et al. Screen for CACNA1A and ATP1A2 mutations in sporadic hemiplegic migraine patients. Cephalalgia 2008; 28:914.
  31. Jen JC, Wan J, Palos TP, et al. Mutation in the glutamate transporter EAAT1 causes episodic ataxia, hemiplegia, and seizures. Neurology 2005; 65:529.
  32. Lykke Thomsen L, Kirchmann Eriksen M, Faerch Romer S, et al. An epidemiological survey of hemiplegic migraine. Cephalalgia 2002; 22:361.
  33. Thomsen LL, Eriksen MK, Roemer SF, et al. A population-based study of familial hemiplegic migraine suggests revised diagnostic criteria. Brain 2002; 125:1379.
  34. BRADSHAW P, PARSONS M. HEMIPLEGIC MIGRAINE, A CLINICAL STUDY. Q J Med 1965; 34:65.
  35. Thomsen LL, Ostergaard E, Olesen J, Russell MB. Evidence for a separate type of migraine with aura: sporadic hemiplegic migraine. Neurology 2003; 60:595.
  36. Thomsen LL, Olesen J. Sporadic hemiplegic migraine. Cephalalgia 2004; 24:1016.
  37. Haan J, Terwindt GM, Ophoff RA, et al. Is familial hemiplegic migraine a hereditary form of basilar migraine? Cephalalgia 1995; 15:477.
  38. Terwindt GM, Ophoff RA, Haan J, et al. Familial hemiplegic migraine: a clinical comparison of families linked and unlinked to chromosome 19.DMG RG. Cephalalgia 1996; 16:153.
  39. Ahmed MA, Reid E, Cooke A, et al. Familial hemiplegic migraine in the west of Scotland: a clinical and genetic study of seven families. J Neurol Neurosurg Psychiatry 1996; 61:616.
  40. Yu W, Horowitz SH. Treatment of sporadic hemiplegic migraine with calcium-channel blocker verapamil. Neurology 2003; 60:120.
  41. Fitzsimons RB, Wolfenden WH. Migraine coma. Meningitic migraine with cerebral oedema associated with a new form of autosomal dominant cerebellar ataxia. Brain 1985; 108 ( Pt 3):555.
  42. Münte TF, Müller-Vahl H. Familial migraine coma: a case study. J Neurol 1990; 237:59.
  43. Spacey SD, Vanmolkot KR, Murphy C, et al. Familial hemiplegic migraine presenting as recurrent encephalopathy in a Native Indian family. Headache 2005; 45:1244.
  44. Spadaro M, Ursu S, Lehmann-Horn F, et al. A G301R Na+/K+ -ATPase mutation causes familial hemiplegic migraine type 2 with cerebellar signs. Neurogenetics 2004; 5:177.
  45. Oberndorfer S, Wöber C, Nasel C, et al. Familial hemiplegic migraine: follow-up findings of diffusion-weighted magnetic resonance imaging (MRI), perfusion-MRI and [99mTc] HMPAO-SPECT in a patient with prolonged hemiplegic aura. Cephalalgia 2004; 24:533.
  46. Vahedi K, Denier C, Ducros A, et al. CACNA1A gene de novo mutation causing hemiplegic migraine, coma, and cerebellar atrophy. Neurology 2000; 55:1040.
  47. Debiais S, Hommet C, Bonnaud I, et al. The FHM1 mutation S218L: a severe clinical phenotype? A case report and review of the literature. Cephalalgia 2009; 29:1337.
  48. Kors EE, Terwindt GM, Vermeulen FL, et al. Delayed cerebral edema and fatal coma after minor head trauma: role of the CACNA1A calcium channel subunit gene and relationship with familial hemiplegic migraine. Ann Neurol 2001; 49:753.
  49. Hayashi R, Tachikawa H, Watanabe R, et al. Familial hemiplegic migraine with irreversible brain damage. Intern Med 1998; 37:166.
  50. Vanmolkot KR, Stroink H, Koenderink JB, et al. Severe episodic neurological deficits and permanent mental retardation in a child with a novel FHM2 ATP1A2 mutation. Ann Neurol 2006; 59:310.
  51. Knierim E, Leisle L, Wagner C, et al. Recurrent stroke due to a novel voltage sensor mutation in Cav2.1 responds to verapamil. Stroke 2011; 42:e14.
  52. Dodick D, Roarke M. Familial hemiplegic migraine: permanent attack-related neurologic deficits. Headache 2007; 47:1210.
  53. Topakian R, Pischinger B, Stieglbauer K, Pichler R. Rare clinical findings in a patient with sporadic hemiplegic migraine: FDG-PET provides diminished brain metabolism at 10-year follow-up. Cephalalgia 2014; 34:392.
  54. Guedj E, Belenotti P, Serratrice J, et al. Partially reversible cortical metabolic dysfunction in familial hemiplegic migraine with prolonged aura. Headache 2010; 50:872.
  55. Terwindt G, Kors E, Haan J, et al. Mutation analysis of the CACNA1A calcium channel subunit gene in 27 patients with sporadic hemiplegic migraine. Arch Neurol 2002; 59:1016.
  56. WHITTY CW. Familial hemiplegic migraine. J Neurol Neurosurg Psychiatry 1953; 16:172.
  57. Razavi M, Razavi B, Fattal D, et al. Hemiplegic migraine induced by exertion. Arch Neurol 2000; 57:1363.
  58. Hansen JM, Hauge AW, Ashina M, Olesen J. Trigger factors for familial hemiplegic migraine. Cephalalgia 2011; 31:1274.
  59. Elliott MA, Peroutka SJ, Welch S, May EF. Familial hemiplegic migraine, nystagmus, and cerebellar atrophy. Ann Neurol 1996; 39:100.
  60. Fernandez DM, Hand CK, Sweeney BJ, Parfrey NA. A novel ATP1A2 gene mutation in an Irish familial hemiplegic migraine kindred. Headache 2008; 48:101.
  61. Terwindt GM, Ophoff RA, Lindhout D, et al. Partial cosegregation of familial hemiplegic migraine and a benign familial infantile epileptic syndrome. Epilepsia 1997; 38:915.
  62. Cha YH, Millett D, Kane M, et al. Adult-onset hemiplegic migraine with cortical enhancement and oedema. Cephalalgia 2007; 27:1166.
  63. Dreier JP, Jurkat-Rott K, Petzold GC, et al. Opening of the blood-brain barrier preceding cortical edema in a severe attack of FHM type II. Neurology 2005; 64:2145.
  64. Lindahl AJ, Allder S, Jefferson D, et al. Prolonged hemiplegic migraine associated with unilateral hyperperfusion on perfusion weighted magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2002; 73:202.
  65. Barbour PJ, Castaldo JE, Shoemaker EI. Hemiplegic migraine during pregnancy: unusual magnetic resonance appearance with SPECT scan correlation. Headache 2001; 41:310.
  66. Masuzaki M, Utsunomiya H, Yasumoto S, Mitsudome A. A case of hemiplegic migraine in childhood: transient unilateral hyperperfusion revealed by perfusion MR imaging and MR angiography. AJNR Am J Neuroradiol 2001; 22:1795.
  67. Hsu DA, Stafstrom CE, Rowley HA, et al. Hemiplegic migraine: hyperperfusion and abortive therapy with intravenous verapamil. Brain Dev 2008; 30:86.
  68. Iizuka T, Takahashi Y, Sato M, et al. Neurovascular changes in prolonged migraine aura in FHM with a novel ATP1A2 gene mutation. J Neurol Neurosurg Psychiatry 2012; 83:205.
  69. Gonzalez-Alegre P, Tippin J. Prolonged cortical electrical depression and diffuse vasospasm without ischemia in a case of severe hemiplegic migraine during pregnancy. Headache 2003; 43:72.
  70. Pierelli F, Pauri F, Cupini LM, et al. Transcranial Doppler sonography in familial hemiplegic migraine. Cephalalgia 1991; 11:29.
  71. Prodan CI, Holland NR, Lenaerts ME, Parke JT. Magnetic resonance angiogram evidence of vasospasm in familial hemiplegic migraine. J Child Neurol 2002; 17:470.
  72. Hansen JM, Schytz HW, Larsen VA, et al. Hemiplegic migraine aura begins with cerebral hypoperfusion: imaging in the acute phase. Headache 2011; 51:1289.
  73. Safier R, Cleves-Bayon C, Vaisleib I, et al. Magnetic Resonance Angiography Evidence of Vasospasm in Children With Suspected Acute Hemiplegic Migraine. J Child Neurol 2013; 29:789.
  74. Mourand I, Menjot de Champfleur N, Carra-Dallière C, et al. Perfusion-weighted MR imaging in persistent hemiplegic migraine. Neuroradiology 2012; 54:255.
  75. Black DF, Kung S, Sola CL, et al. Familial hemiplegic migraine, neuropsychiatric symptoms, and Erdheim-Chester disease. Headache 2004; 44:911.
  76. Thomsen LL, Olesen J, Russell MB. Increased risk of migraine with typical aura in probands with familial hemiplegic migraine and their relatives. Eur J Neurol 2003; 10:421.
  77. Thomsen LL, Ostergaard E, Romer SF, et al. Sporadic hemiplegic migraine is an aetiologically heterogeneous disorder. Cephalalgia 2003; 23:921.
  78. Lambru G, Nesbitt A, Shanahan P, Matharu MS. Coexistence of hemiplegic migraine with SUNCT or SUNA: a case series. Cephalalgia 2012; 32:258.
  79. Dichgans M, Herzog J, Freilinger T, et al. 1H-MRS alterations in the cerebellum of patients with familial hemiplegic migraine type 1. Neurology 2005; 64:608.
  80. Kors EE, Melberg A, Vanmolkot KR, et al. Childhood epilepsy, familial hemiplegic migraine, cerebellar ataxia, and a new CACNA1A mutation. Neurology 2004; 63:1136.
  81. Stam AH, Luijckx GJ, Poll-Thé BT, et al. Early seizures and cerebral oedema after trivial head trauma associated with the CACNA1A S218L mutation. J Neurol Neurosurg Psychiatry 2009; 80:1125.
  82. Barros J, Damásio J, Tuna A, et al. Cerebellar ataxia, hemiplegic migraine, and related phenotypes due to a CACNA1A missense mutation: 12-year follow-up of a large Portuguese family. JAMA Neurol 2013; 70:235.
  83. Al-Bulushi B, Al-Hashem A, Tabarki B. A wide clinical phenotype spectrum in patients with ATP1A2 mutations. J Child Neurol 2014; 29:265.
  84. Grimaldi D, Tonon C, Cevoli S, et al. Clinical and neuroimaging evidence of interictal cerebellar dysfunction in FHM2. Cephalalgia 2010; 30:552.
  85. Le Fort D, Safran AB, Picard F, et al. Elicited repetitive daily blindness: a new familial disorder related to migraine and epilepsy. Neurology 2004; 63:348.
  86. Stam AH, Louter MA, Haan J, et al. A long-term follow-up study of 18 patients with sporadic hemiplegic migraine. Cephalalgia 2011; 31:199.
  87. Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 2013; 33:629.
  88. Silverman IE, Wityk RJ. Transient migraine-like symptoms with internal carotid artery dissection. Clin Neurol Neurosurg 1998; 100:116.
  89. Mirza Z, Hayward P, Hulbert D. Spontaneous carotid artery dissection presenting as migraine--a diagnosis not to be missed. J Accid Emerg Med 1998; 15:187.
  90. Haraguchi K, Toyama K, Ito T, et al. A case of posterior cerebral artery dissection presenting with migraine-like headache and visual field defect: usefulness of fast imaging employing steady-state acquisition (FIESTA) for diagnosis. J Stroke Cerebrovasc Dis 2012; 21:906.e5.
  91. Bartleson JD, Krecke KN, O'Neill BP, Brown PD. Reversible, strokelike migraine attacks in patients with previous radiation therapy. Neuro Oncol 2003; 5:121.
  92. Black DF, Bartleson JD, Bell ML, Lachance DH. SMART: stroke-like migraine attacks after radiation therapy. Cephalalgia 2006; 26:1137.
  93. Kerklaan JP, Lycklama á Nijeholt GJ, Wiggenraad RG, et al. SMART syndrome: a late reversible complication after radiation therapy for brain tumours. J Neurol 2011; 258:1098.
  94. Berg MJ, Williams LS. The transient syndrome of headache with neurologic deficits and CSF lymphocytosis. Neurology 1995; 45:1648.
  95. Fuentes B, Diez Tejedor E, Pascual J, et al. Cerebral blood flow changes in pseudomigraine with pleocytosis analyzed by single photon emission computed tomography. A spreading depression mechanism? Cephalalgia 1998; 18:570.
  96. De Benedittis G, Ferrari Da Passano C, Granata G, Lorenzetti A. CBF changes during headache-free periods and spontaneous/induced attacks in migraine with and without aura: a TCD and SPECT comparison study. J Neurosurg Sci 1999; 43:141.
  97. Kansagra S, Mikati MA, Vigevano F. Alternating hemiplegia of childhood. Handb Clin Neurol 2013; 112:821.
  98. Koo B, Becker LE, Chuang S, et al. Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes (MELAS): clinical, radiological, pathological, and genetic observations. Ann Neurol 1993; 34:25.
  99. Steele JG, Nath PU, Burn J, Porteous ME. An association between migrainous aura and hereditary haemorrhagic telangiectasia. Headache 1993; 33:145.
  100. de Grauw TJ, Smit LM, Brockstedt M, et al. Acute hemiparesis as the presenting sign in a heterozygote for ornithine transcarbamylase deficiency. Neuropediatrics 1990; 21:133.
  101. Silva GS, Almeida CM, Félix EP, et al. [Cerebral venous thrombosis and homocystinuria: case report]. Arq Neuropsiquiatr 2001; 59:815.
  102. Dora B, Balkan S. Sporadic hemiplegic migraine and Sturge-Weber syndrome. Headache 2001; 41:209.
  103. Jung A, Raman A, Rowland Hill C. Acute hemiparesis in Sturge-Weber syndrome. Pract Neurol 2009; 9:169.
  104. Tobita M, Hino M, Ichikawa N, et al. A case of hemiplegic migraine treated with flunarizine. Headache 1987; 27:487.
  105. Peer Mohamed B, Goadsby PJ, Prabhakar P. Safety and efficacy of flunarizine in childhood migraine: 11 years' experience, with emphasis on its effect in hemiplegic migraine. Dev Med Child Neurol 2012; 54:274.
  106. Athwal BS, Lennox GG. Acetazolamide responsiveness in familial hemiplegic migraine. Ann Neurol 1996; 40:820.
  107. Battistini S, Stenirri S, Piatti M, et al. A new CACNA1A gene mutation in acetazolamide-responsive familial hemiplegic migraine and ataxia. Neurology 1999; 53:38.
  108. Pascual J, Caminero AB, Mateos V, et al. Preventing disturbing migraine aura with lamotrigine: an open study. Headache 2004; 44:1024.
  109. Lampl C, Katsarava Z, Diener HC, Limmroth V. Lamotrigine reduces migraine aura and migraine attacks in patients with migraine with aura. J Neurol Neurosurg Psychiatry 2005; 76:1730.
  110. Steiner TJ, Findley LJ, Yuen AW. Lamotrigine versus placebo in the prophylaxis of migraine with and without aura. Cephalalgia 1997; 17:109.
  111. Kaube H, Herzog J, Käufer T, et al. Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine. Neurology 2000; 55:139.
  112. Centonze V, Brucoli C, Macinagrossa G, et al. Non-familial hemiplegic migraine responsive to naloxone. Cephalalgia 1983; 3:125.
  113. Klapper J, Mathew N, Nett R. Triptans in the treatment of basilar migraine and migraine with prolonged aura. Headache 2001; 41:981.
  114. Artto V, Nissilä M, Wessman M, et al. Treatment of hemiplegic migraine with triptans. Eur J Neurol 2007; 14:1053.
  115. Evans RW, Lipton RB. Topics in migraine management: a survey of headache specialists highlights some controversies. Neurol Clin 2001; 19:1.
  116. Prendes JL. Considerations on the use of propranolol in complicated migraine. Headache 1980; 20:93.
  117. Gilbert GJ. An occurrence of complicated migraine during propranolol therapy. Headache 1982; 22:81.
  118. Mjåset C, Russell MB. Intravenous nimodipine worsening prolonged attack of familial hemiplegic migraine. J Headache Pain 2008; 9:381.