Contents

SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Hemiplegic migraine
Other Resources UpToDate PubMed

Hemiplegic migraine

Contributors: Andrea Wasilewski MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Hemiplegic migraine (HM) is a rare variant of migraine with aura that presents with episodic and reversible attacks of headache and unilateral motor weakness, usually beginning as an aura prior to the headache. Patients may also present with impaired level of consciousness, ataxia, sensory loss, vision changes, or brainstem symptoms. Symptoms typically last from hours to days, and neurologic symptoms may outlast the associated headache. Symptoms typically occur over 10-30 minutes but may present acutely and mimic an acute stroke.

To diagnose HM, patients must have episodic, unilateral, reversible motor weakness as a migraine aura, as well as at least one other type of aura. Between attacks, patients typically have a normal neurologic examination.

HM is a rare condition occurring with a prevalence of 0.01%. HM is more prevalent in women than men (3:1), with an age of onset in the teenage years. HM has been associated with mutations in CACNA1A, ATP1A2, and SCN1A genes, which can be sporadic or familial. Inheritance in familial HM is autosomal dominant, although penetrance is incomplete. Patients with HM, cerebellar findings, and developmental delay should be tested for CACNA1A gene mutations. Patients with HM and associated epilepsy should be tested for ATP1A2 gene mutations. Many patients with HM do not demonstrate any of these known gene mutations.

Codes

ICD10CM:
G43.409 – Hemiplegic migraine, not intractable, without status migrainosus

SNOMEDCT:
59292006 – Hemiplegic migraine

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

To perform a comparison, select diagnoses from the classic differential

Subscription Required

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:01/18/2022
Last Updated:02/27/2022
Copyright © 2024 VisualDx®. All rights reserved.
Hemiplegic migraine
Print  
A medical illustration showing key findings of Hemiplegic migraine : Headache, Numbness, Nystagmus, Visual impairment, Paresthesias, Dysphasia
Copyright © 2024 VisualDx®. All rights reserved.