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Anesthesiology8 papers

Hemiplegic migraine

Last edited: 4/16/2026

Overview

Hemiplegic migraine is a rare subtype of migraine characterized by unilateral motor weakness (hemiplegia) accompanying typical migraine headache symptoms 1.

Diagnosis

  • Presence of typical migraine headache with aura
  • Associated with unilateral motor weakness (hemiplegia)
  • Often includes additional neurological symptoms such as visual disturbances or sensory changes
  • Neuroimaging (MRI, MRA) may help identify vascular abnormalities 1

    • Management

  • First-line treatments:
    • - Preventive medications: Beta-blockers, anticonvulsants (e.g., valproate), and calcium channel blockers 1
  • Adjunctive treatments:
    • - Acute attacks: Triptans are generally contraindicated due to risk of stroke; alternative options include NSAIDs or corticosteroids 1 - Surgical intervention: For patients with confirmed arterial component, surgical cautery of selected terminal branches of the external carotid artery may be considered 1

    Special Populations

  • Pregnancy: Specific management guidelines not addressed in provided abstracts 1
  • Pediatrics: Management strategies not detailed in the abstracts 1
  • Elderly: Considerations for comorbidities and medication safety not explicitly covered 1
  • Comorbidities: Focus on cardiovascular risks; surgical options may be considered in cases with arterial components 1

    • Key Recommendations

  • Consider preventive medications such as beta-blockers, anticonvulsants, and calcium channel blockers for managing hemiplegic migraine (Evidence: Moderate) 1
  • Avoid triptans in acute attacks due to stroke risk; consider NSAIDs or corticosteroids as alternatives (Evidence: Expert opinion) 1
  • For patients with confirmed arterial components and refractory symptoms, surgical cautery of selected terminal branches of the external carotid artery may be an effective treatment option (Evidence: Weak) 1

    • References

    1 Shevel E. Arterial surgery for sporadic hemiplegic migraine: preliminary results. The British journal of oral & maxillofacial surgery 2014. link

    Original source

    1. [1]
      Arterial surgery for sporadic hemiplegic migraine: preliminary results. — Shevel E The British journal of oral & maxillofacial surgery (2014)
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