Hemiplegia—Migraines that can Paralyze

Imagine having a migraine that was so bad that it suddenly began to resemble the signs and symptoms of a stroke and you began to experience limited paralysis on one side of the body.  It is a scary thought, but it is reality for some people who struggle with really bad migraines.  This condition is called hemiplegia.

What is Hemiplegia?

Hemiplegia is a lesser-known condition that is caused by a brain injury and results in varying degrees of weakness, stiffness, and lack of control in one side of the body.  In cases of hemiplegia, the injured area of the brain tends to be the regions that are involved in controlling movement like that of the limbs, body, and face, and this injury tends to occur before, during or after birth—up to two years of age.  If it is the result of an injury in early infancy, the term used to describe it is congenital hemiplegia, but if an injury or illness triggers it in later life, then it is referred to as acquired hemiplegia, but it is a lot more complicated than this.

Hemiplegia is a rather rare condition, and it affects approximately 1 in 1,000 children, and 80% of those cases tend to be congenital.  What complicates this situation is that hemiplegia affects each child differently.  The difference between hemiplegia and cerebral palsy, a condition that also effects movement and posture because of brain injury, is that hemiplegia is life-lasting and non-progressive, and its symptoms may change over time as a child grows and develops.  Some of the most reported symptoms in children are a sensation imbalance between the two hands, with one being more tired or stiff than the other; the affected hand is also more sensitive to hot or cold temperatures, but sometimes there can be a sensation impairment that is so high that it impairs a child’s ability to tell the difference between two temperatures at all.

If a person is not diagnosed in their early childhood or adolescent years with hemiplegia, doctors tend to identify and diagnose two types of hemiplegic migraines: familial hemiplegic migraines and sporadic hemiplegic migraines.  Familial hemiplegic migraines are the diagnosis that doctors give a patient when at least two of their close relatives also struggle with the same migraines, and it is believed that it can be inherited.  Sporadic hemiplegic migraines are the diagnosis when there is no family history of these migraines.  However, hemiplegia is rarely a standalone diagnosis, and there tends to be other, more obvious, undiagnosed conditions like visual impairment, epilepsy, and speech difficulties.  But there are also less obvious challenges, such as emotional and behavioral problems, specific learning difficulties, and perceptual problems.  Since hemiplegic migraines are difficult to diagnose in adults, and because they have similar symptoms as more serious illnesses, there are additional steps that can be taken to rule out those serious illnesses such as getting a Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan, or perhaps an electroencephalogram (EEG) or an echocardiogram.

Members of the medical community have identified higher risks for hemiplegia in babies that are born very premature, also, the more pregnancies a woman has the greater the chance for hemiplegia, but it is still unknown whether a difficult birth may be a contributing factor.  There also seems to be some unique genes involved.   One of the most complex aspects of congenital hemiplegia that has troubled researchers has to do with them trying to identify the exact point in a pregnancy that causes a fetus to develop hemiplegia, but they have not been able to isolate specific contributing factors.

Living with Hemiplegic Migraines.

For people who would prefer to attempt to manage living with hemiplegic migraines without the use of medication, there are some common triggers that can be avoided to reduce the likelihood of triggering a migraine headache, including stress, bright lights, loud sounds, too little or too much sleeping, alcohol, caffeine, skipping meals, and saturated fats and salty foods.

When it comes to medication, there are two types of medication that can be prescribed to treat it: preventative medication and abortive medication.  Preventative medication is designed to prevent migraines before they happen and include beta blockers (primarily used to treat cardiovascular conditions), the cosmetic procedure known as Botox, antidepressants, CGRP antagonists (a medication created focusing on migraines), and anticonvulsants (primarily used to treat epilepsy).  Abortive medication is designed to stop a migraine once they occur, and it includes getting injected with IV fluids and oral medication like NSAIDS such as ibuprofen and aspirin.

Tips about insurance coverage.

One thing about insurance coverage that sometimes gets overlooked by those with private insurance is that insurance companies will cover a whole lot of things when it comes to medical health, but they require that it is prescribed by your family doctor.  In cases of complex migraines, like hemiplegic migraines, as long as your family doctor details your migraine history and past treatments plans, insurance providers are obligated to cover standalone or combined treatment plans if that is what is being recommended.  However, there may be differences with insurance deductibles, coverage subsidies, and the total coverage limit offered by an insurance company, but they still do cover a whole lot of things.

Although some insurance company representatives might tell you that your insurance plan will not cover or that they will not consider combined treatment plans with two classes of drugs together, this is a grey area, and your family doctor will have to fill out some special exemption forms.  Since insurance companies train their agents so that every response sounds like a “hard no”, it is best to always consult with your family doctor because there is a growing list of special exemptions.  So remember, just because it sounds like a “hard no” does not always mean it is, and the only way to get to the real answer is by connecting with your family doctor.

Hemiplegic Migraine – StatPearls – NCBI Bookshelf (nih.gov)
Review: Diagnostic and therapeutic aspects of hemiplegic migraine – PMC (nih.gov)