HEMIPLEGIC MIGRAINES

well my boyfriend suffers from hemeplegic migraines so i know a little bit about this type and i know that they can be pretty scary for a person i someone they know i having one of there migraines and they are not familar with the migraine they can have serious mistreatments since the symptoms resembles a stroke.
my boy friend is on medication to prevent his migraines which is anitrypline 100mgs at bedtime then when he actually get his migraines he swicthes off every two hours from midrn and foiricet. the midrin usually gets the edge of enough so he can get home before his body shuts down completly.

the anatrypline works really well for him to the point he only gets migraines rarely and since he has been suffering from these since he was little he can recognize the signs early enough to get to his medication.

~Dink~

Hi Jessikah,

I'm sorry to hear about the trouble your family is having with your medical system. I live in Canada and we have similar problems. Here we don't die because we can't afford medical care we die because we're waiting for care. I don't know anything about your system, but one thing that works here is the Emergency Room, though you can end up waiting for a long time. If your dad were to get worse or new symptoms were to emerge could he go to the Emergency Room to be treated? That way you would know that it's not a stroke or blood clot.

I don't know that any country has figured out proper medical care.

Hello,

Having worked in the US and Canada but always been a resident of Canada its something I've discussed with many people and struggle with. As Canadians we tout the benefits of our "socialized" medical system and the fact that everyone get care but the type of care is scary. I get to spend 10 minutes with my neurologist every 3 months - lucky me. Even if I wanted to, or could afford it, I can't pay to see him longer or see another neurologist for longer. The original waiting list for the neurologist is 3 to 6 months if you're lucky. It's crazy. I haven't had an MRI or CAT scan. The neurologist does visual tests, and has me touch my nose, takes a history and is sure I don't have a tumor plus an MRI or CAT would take years to happen.

I read about those of you with the huge doctor and hospital bills and I'm thankful I don't have them. I'm also thankful that my husband's and my extended health coverage covers all of our prescriptions or we wouldn't be able to afford them and when I needed time off work my disability insure from work continued to pay me. At a certain money point the government kicks in and starts paying for my prescriptions and somehow that means our medication costs are lower than in the US (I'm not sure why), and that's another benefit.

I guest there are plusses and minuses to all types of coverage.

Hi Jessikah,

I'm sorry to hear that your dad is still having problems. When you mentioned MS I went back and looked at his symptoms and you may want to post a message on the MS forum. My step-mother has MS and your dad's symptoms sound very similar. I can't believe I didn't think of it before. The good news is that they might have medication to give him to slow the progress if it is. The bad news is the end result. The MRI should give a good indication of MS.

Good luck! Either way I hope they find out what's wrong.

Hi Jessikah,

Hang in there! The good news is that you're close to a diagnosis. Check out the MS forum. The group there is great. I go there sometimes because my stepmom has it.

Depression is a common side effect / symptom of MS, psychological counselling is recommended and can be helped. Depending on the type of MS he has there may be medications that he can take to slow the progression of symptoms.

The positive side - if you can see one right now - is that he's not likely to die of MS like he could of a stroke or heart disease, he will lose his mobility but you will still have the man you love with you. They have made many advances in MS in the past many years.

In case you're seeking any unsolicited advice be there for him, ask him what he needs and reassure him of your love. Talk about it as much or as little as he wants. My stepmom has had MS for 20 years but its only recently started to get worse. She doesn't like to talk about it but has been a lot more lately. Whenever she does we're as supportive as possible.

I've heard yoga, swimming and generally any movement is good to keep the body moving.

I will add my email address to my profile so that you can click on my email icon next to my name if you'd like to email me personally for some support. Watching a parent go through something like this is hard.

so sorry bethuk. so yours started all the sudden also? no one understands the definition of panic better than someone with hemiplegic migraines that is unable to speak properly etc. it terrifies me every time it happens. youre right its easy to get depressed just because its so frustrating!! i hope eventually they will find a cause and a cure. meanwhile we just have to hang in there and try to educate people about it and stay positive. i went through a long period of depression when it first started happening to me and the migraines were constant. now that they are less frequent like yours i think it is some easier to accept. its still hard when you dont know when you are going to be totally debilitated and for how long again! good luck to you

bethunk best of luck with your doctor visit, or have you already went? Fioricet is actually for tension headaches or migraines caused from stress. it will help relax you and those muscles that get tight in the back of your neck etc, so i hops your doc will try you on it at least! i dont know why it also usually works on my hemiplegic migraines unless it's a bad one it won't.  i've  also been through the doctor telling me my headaches are stress related from my stressful job, but i don't buy that. yes that can make it worse, but i've had plenty of migraines when i feel no stress at all!

i want to know what everyone thinks may cause these type of migraines. i do not have any family history for hemiplegics. mine seem to really hit hard starting in around october or so.  i have wondered if anyone else has experienced the same thing? i've thought that maybe allergies may have to do with it? i also have wondered if maybe vicodin could have to do with it? i've been on that a long time, and they never started till i was on it a couple months. but i had quit taking the vicodin for a while and bam got hit with the worst one ever! so maybe not. that miraine may also have been caused cause i quit taking the muscle relaxer - unsure but definitely taking both again! i have also wondered about constipation, because i notice that when i havent used the bathroom for a while it really increases my headaches and nauseation. anyone have anything simular happen?

I am an EMT in Indiana. I also work in Kentucky. I used to have a patient that had hemiplegic migraines. They intrigued me so I looked them up. I am very willing to help anyone I can as far as information or recources. It was a very interesting process to watch someone go through.

http://headaches.about.com/od/migrainediseas1/a/hemiplegic_mig.htm
http://headaches.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=headaches&zu=http%3A%2F%2Fhelpforheadaches.com%2Farticles%2Fhemiplegic.htm
http://www.migraines.org/
http://www.webmd.com/content/article/4/1680_51678.htm
http://www.emedicine.com/neuro/topic219.htm
http://www.ninds.nih.gov/disorders/headache/detail_headache.htm

HEMIPLEGIC MIGRAINE

Hemiplegic migraine is a very rare form of migraine that is considered to be one of the more severe types of migraine. The sufferer may develop some temporary motor paralysis on one side of the body. This may be accompanied by numbness or a pins-and-needles sensation. The neurological symptoms usually leave when the headache appears.



With hemiplegic migraine, there is often a familial occurrence. In about 50% of these families, a chromosome defect may be found on chromosome 19 or on chromosome 1 and involves abnormal calcium channels. A physician should be consulted for this type of headache. You should not take triptans if you have this type of headache.

From: http://www.headaches.org/consumer/topicsheets/hemiplegic.html


These are some helpful links and excerpts. I have only had two patients that have had hemiplegic migraines. One of them got the condition from a chiropractor's mishandling and illegal practicing of medicine. He is currently under investigation and is being named in a lawsuit by this patient. SHe had some back pain and went in to a DC and he manipulated her body and did not disclose certain facts. She is now 24 years old and paralyzed. SHe goes into periods of being semi to uncounscious. When she is semi, she fits the signs and symptoms word for word fro a stroke. This was the first time I had ever taken this patient in my ambulance. I was prepared to take her to the regional stroke center. It did not matter that she is 24 and until this incident, was in the perfect state of health. I was advised that the way I was seeing her was her"normal" state. She has been to the National Headache Clinic in Chicago. She has over $1,000,000 in medical bills. She is disabled for the rest of her life. She is funnier than hell when she is awake. She has also almost died several times due to various surgeries including invasive neurosurgery. She has a factsheet wheich CLEARLY STATE her allergies and medical history including surgeries so if EMS gets to her house and she is alone and unresponsive, they will know maybe what is going on. It is a very dangerous condition and needs to be carefully monitored by the patient and their family as well as their doctor(s) Family Doctor and Neurologist.

Source: http://headaches.about.com/gi/dynamic/offsite.htm?zi=1/XJ&sdn=headaches&zu=http%3A%2F%2Fhelpforheadaches.com%2Farticles%2Fhemiplegic.htm

What Is Hemiplegic Migraine?




To understand Hemiplegic Migraine, we have to understand that Migraine attacks are episodic manifestations of a genetic neurological disease. Migraine can present in a variety of ways. Hemiplegic Migraine is a rare form of Migraine, made more confusing by there being two variations: Familial Hemiplegic Migraine (FHM) and Sporadic Hemiplegic Migraine (SHM).

Both FHM and SHM often begin in childhood and cease during adult years. Diagnosing FHM and SHM can be difficult as the symptoms are also indicative of vascular disease. and can be thought to be stroke, epilepsy, or other conditions. A full neurological work up and careful review of medical history and symptoms are necessary to rule out other causes and confirm a diagnosis of FHM or SHM. Family medical history is especially helpful in diagnosing FHM.

FHM and SHM share the same symptoms, which will vary among different Migraineurs. The difference between the two is that FHM can be traced back in the family history and has been linked to mutations of specific genes on chromosomes 1 and 19. SHM is FHM without the familial connection and that particular genetic mutation.

Symptoms of FHM and SHM:

*

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

Hemiplegia (paralysis on one side of the body)
*

Fever
*

Meningismus (symptoms of meningitis without the actual illness and accompanying inflammation)
*

Impaired consciousness ranging from confusion to profound coma
*

Headache, which may begin before the hemiplegia or be absent
*

Ataxia (defective muscle coordination)
*

The onset of the hemiplegia may be sudden and simulate a stroke.¹
*

Nausea and/or vomiting
*

Phonophobia and/or photophobia

Treatment of FHM and SHM:
Treatment of Hemiplegic Migraine can be challenging. The symptoms are greater in number and more difficult to treat. Those who experience Hemiplegic Migraines absolutely need to educate themselves about their disease and treatment. It's very common to need to seek the care of an excellent Migraine specialist with an established track record for treatment as many other doctors have never treated a case of Hemiplegic Migraine.

*

Abortive and Pain Relief: Migraine-specific abortives, the triptans and ergotamines, are currently contraindicated in the treatment of Hemiplegic Migraine because of their vasoconstrictive properties and concerns about stroke. One small study was conducted, safely using triptans with patients with Hemiplegic Migraine, but more trials are needed before they're considered a safe option.2 Since the triptans and ergotamines aren't options, other treatments such as NSAID's, antiemetics, and narcotic analgesics are generally used for relief of Hemiplegic Migraine.
*

Preventive: Given the severity of the symptoms and the contraindication of abortive medications, preventive regimens are considered especially important in the treatment of Hemiplegic Migraine. As noted above the genes for FHM are mapped on chromosomes 1 and 19, These code for the calcium channel. "The mutant calcium channel does not open and close properly and cannot regulate the amount of calcium coming into the cell, so calcium influx and efflux regulation goes awry. This in turn leads to neurons firing too easily."3 For this reason, calcium channel blockers are sometimes especially effective preventive medications for FHM.

A Word of Caution:
Migraineurs with Hemiplegic Migraine should give special consideration to wearing some kind of medical identification at all times since an attack can lead to impaired consciousness and an inability to speak. Medical identification can save valuable time in an emergency and assure that proper treatment is received far more quickly.



Diagnostic Criteria from the International Headache Society4:

Familial hemiplegic migraine (FHM)
Description: Migraine with aura including motor weakness and at least one first- or second-degree relative has migraine aura including motor weakness.
Diagnostic criteria:

1.

At least 2 attacks fulfilling criteria B and C
2.

Aura consisting of fully reversible motor weakness and at least one of the following:
1.

fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision
2.

fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (i.e., numbness)
3.

fully reversible dysphasic speech disturbance
3.

At least two of the following:
1.

at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
2.

each aura symptom lasts ≥5 minutes and <24 hours
3.

headache fulfilling criteria B–D for Migraine without aura begins during the aura or follows onset of aura within 60 minutes
4.

D. At least one first- or second-degree relative has had attacks fulfilling these criteria A–E

Comments:
It may be difficult to distinguish weakness from sensory loss. New genetic data have allowed a more precise definition of FHM than previously. Specific genetic subtypes of 1.2.4 Familial hemiplegic migraine have been identified: in FHM1 there are mutations in the CACNA1A gene on chromosome 19, and in FHM2 mutations occur in the ATP1A2 gene on chromosome 1.

Sporadic hemiplegic migraine
Description: Migraine with aura including motor weakness but no first- or second-degree relative has aura including motor weakness.
Diagnostic criteria:

1.

At least 2 attacks fulfilling criteria B and C
2.

Aura consisting of fully reversible motor weakness and at least one of the following:
1.

1. fully reversible visual symptoms including positive features (e.g., flickering lights, spots or lines) and/or negative features (i.e., loss of vision)
2.

2. fully reversible sensory symptoms including positive features (i.e., pins and needles) and/or negative features (ie, numbness)
3.

3. fully reversible dysphasic speech disturbance
3.

At least two of the following:
1.

1. at least one aura symptom develops gradually over ≥5 minutes and/or different aura symptoms occur in succession over ≥5 minutes
2.

2. each aura symptom lasts ≥5 minutes and <24 hours
3.

3. headache fulfilling criteria B–D for Migraine without aura begins during the aura or follows onset of aura within 60 minutes
4.

No first- or second-degree relative has attacks fulfilling these criteria A–E

Comments:
Epidemiological studies have shown that sporadic cases occur with approximately the same prevalence as familial cases. The attacks have the same clinical characteristics as those in Familial hemiplegic migraine. Sporadic cases always require neuroimaging and other tests to rule out other cause. A lumbar puncture is also necessary to rule out pseudomigraine with temporary neurological symptoms and lymphocytic pleocytosis. This condition is more prevalent in males and often associated with transient hemiparesis and aphasia.

Migraine without aura
Description:
Recurrent headache disorder manifesting in attacks lasting 4–72 hours. Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, aggravation by routine physical activity and association with nausea and/or photophobia and phonophobia.
Diagnostic criteria:

1.

At least 5 attacks1 fulfilling criteria B–D
2.

Headache attacks lasting 4–72 hours (untreated or unsuccessfully treated)
3.

Headache has at least two of the following characteristics:
1.

unilateral location
2.

pulsating quality
3.

moderate or severe pain intensity
4.

aggravation by or causing avoidance of routine physical activity (e.g., walking or climbing stairs)
4.

During headache at least one of the following:
1.

nausea and/or vomiting
2.

photophobia and phonophobia



¹ Silberstein, Stephen D., Lipton, Richard B., Goadsby, Peter J., Smith, Robert T. "Headache in Primary Care". Isis Medical Media Ltd. 1999.

2 Klapper, J., Mathew, N. & Nett, R. (2001) "Triptans in the Treatment of Basilar Migraine and Migraine With Prolonged Aura." Headache: The Journal of Head and Face Pain 41 (10), 981-984. doi: 10.1046/j.1526-4610.2001.01192.x

3 Tepper, Stewart J., M.D. "Understanding Migraine and Other Headaches." University Press of Mississippi. 2004. p. 23.

4 The International Classification of Headache Disorders, Second Edition. The International Headache Society. 2004.

Last Updated October 3, 2004



NOTE: The information on this site is for education and support only. It is not medical advice and should not be construed as such. Always consult your physician if you have new or different symptoms. Never change your treatment regimen or add herbals, supplements, etc., without consulting your doctor.

Hi,

Navydoc - thank you for that very informative piece.

Sun Lover - So sorry you have had such apalling experiences in the ER. Has your Neuro filled out a form to state exactly what your needs are? If not I will bump up a post from tysmyboo our other moderator. These forms have been very useful to some here, as they state exactly what treatment is needed, so you should not get fobbed off with treatments that do not work, or worse nothing at all.

take care

Ann