Hemiplegic Migraines: How to Spot Them and What To Do

Hemiplegic migraine can look like a stroke. One moment you have a headache or aura; the next your arm or face feels weak on one side. That’s what makes these attacks scary. Knowing the signs and the right steps can keep you safer and help you get the right care fast.

Hemiplegic migraines cause temporary weakness or paralysis on one side of the body. Other common signs are visual changes, numbness, slurred speech, confusion, and the usual migraine pain or sensitivity to light and sound. In some people the weakness comes first; in others it follows an intense aura.

What causes hemiplegic migraine?

Some cases run in families and are called familial hemiplegic migraine. Doctors have found gene changes linked to that form, but not everyone with hemiplegic attacks has a known genetic cause. Triggers often match other migraines: strong smells, bright lights, lack of sleep, dehydration, stress, certain foods, or hormonal changes.

Because symptoms can mirror stroke or seizure, doctors may order imaging (CT or MRI) or blood tests to rule out other causes. If symptoms are new, sudden, or severe, emergency evaluation is needed to exclude life-threatening problems.

How are attacks treated and prevented?

During an attack, focus on safety and symptom relief. Rest in a quiet, dark room. Use cool compresses and stay hydrated. Simple painkillers (acetaminophen or ibuprofen) and anti-nausea meds can help. Many neurologists avoid typical migraine drugs that narrow blood vessels—like ergots—and often advise caution with triptans for people with motor weakness. Always follow specialist advice.

For prevention, doctors may try medicines used for other migraine types: certain anti-seizure drugs (like topiramate or valproate), beta-blockers, or calcium channel blockers. Some people benefit from lifestyle changes: keeping a sleep routine, tracking triggers in a diary, avoiding skipping meals, and managing stress. A headache specialist or neurologist can tailor a plan and consider genetic testing if family history suggests it.

When to call for help? If weakness or speech problems start suddenly, if symptoms are getting worse, if the attack lasts much longer than usual, or if you have a high fever or seizures — get emergency care right away. Timely evaluation rules out stroke and gets you the right treatment sooner.

Living with hemiplegic migraine means planning and knowing your personal warning signs. Work closely with your doctor, keep a clear record of attacks, and make a simple action plan for when an attack starts. That way you can reduce panic, get faster care, and manage attacks more effectively.