Hemiplegic migraine is a rare form of migraine with aura in which one side of the body becomes weak during the aura. Because that is also how a stroke presents, a first episode is treated as a stroke until proven otherwise, and the diagnosis is made afterwards rather than in the moment.
Hemiplegic migraine is a rare form of migraine with aura in which one side of the body becomes weak during the aura. Because that is also how a stroke presents, a first episode is treated as a stroke until proven otherwise, and the diagnosis is made afterwards rather than in the moment.
The aura develops gradually rather than suddenly, over several minutes, and typically moves through visual disturbance, then spreading numbness or tingling, then weakness on one side. Speech is often affected. The gradual spread is characteristic and is one of the features that distinguishes it from a stroke, where deficits usually arrive all at once. Weakness can last hours and occasionally days, outlasting the other aura features. Headache generally follows, though not always. Confusion, drowsiness and fever occur in more severe attacks.
Where at least one close relative has the same pattern the condition is termed familial hemiplegic migraine, and several causative genes have been identified, each affecting ion transport across neuronal membranes. Where there is no family history it is termed sporadic, and the presentation is otherwise similar. Genetic testing is available and is most informative where the family history is suggestive; it is arranged rather than performed at these offices, and it is worth discussing what a result would change before testing rather than after.
Sudden one-sided weakness with speech difficulty is the presentation of a stroke, and no clinician can distinguish the two reliably at the bedside during a first episode. Treating it as a stroke is correct, not an overreaction, because stroke treatment is time-critical. Once the diagnosis is established, later attacks that follow the person's familiar pattern can usually be managed at home with a plan agreed in advance. Any attack that differs from that pattern should be treated as a new event.
Management is preventive rather than acute, because the acute options used in other migraine are generally avoided here: triptans and ergots are not usually recommended in hemiplegic migraine given the vasoconstrictive mechanism and the diagnostic ambiguity. Preventive treatment is chosen from classes with evidence in migraine with aura, and trigger management, sleep regularity and avoiding minor head trauma all matter. MRI is arranged at an imaging centre. Adults 18 and older are seen at either office; this practice provides no emergency care.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: migraine; National Institute of Neurological Disorders and Stroke; American Academy of Neurology.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.