Hemiplegic migraine?

[SanibelSandy]

I an a 61-year old female with a 45-year history of classic migraine (with aura). In 2007 I was diagnosed with a right-sided internal carotid cave aneurysm and underwent stent-assisted coiling to close off the aneurysm. The procedure successfully closed off the aneurysm, but the nature of my migraines has changed. The aura has changed somewhat in nature (flashing lights vs. "heat waves") though the scotoma still occurs and the aura is still bilateral. Until the procedures to treat the aneurysm, my migraines were bilateral. Since the procedures, the migraines I have had have all been right-sided. In addition, one to two days after the migraine, I have had weakness and numbness in my left arm, lasting anywhere from 20 minutes or so to a couple of hours. My internist raised the question of whether these might be hemiplegic migraines. I kind of dismissed that suggestion as my understanding is that the paralysis associated with hemiplegic migraines occurs during the headache phase of the migraine rather than post-headache. Still I wonder about the seeming correlation between the migraines and the occurence of the numbness/weakness in the arm. I did have an arteriogram in December which confirmed the aneurysm is completely sealed off and am on an anti-coagulant, so the likelihood of stroke or TIA is probably quite low. So, could this possibly be an atypical presentation hemiplegic migraine? Any input/insight would be appreciated. I will be seeing my internist again on Monday and will discuss with him possible follow-up with a neurologist so we'll see what he recommends. Thanks.

[DrNoopurMD]

Hi,

The possibility of hemiplegic migraine needs to be looked into because your symptoms are quite suggestive. It is necessary for the hemiplegia or weakness and numbness to occur during the headache phase. Infact many a times headache occurs before the hemiplegia, so it is very possible that your symptoms are due to hemiplegic migraine.
It is advisable to undergo further testing to confirm this diagnosis. The treatment can be quite challenging and you may need to consult a migraine specialist.
Thanks

[SanibelSandy]

Thank you so much for your response to my question. It was quite helpful. I will indeed discuss this with my internist when I see him on Monday. I did see a migraine specialist at Mayo Clinic Jacksonville last year, but that was prior to the aneurysm diagnosis/treatment so I have not seen him re. the hemiplegic migraine question. I will probably consult a local neurologist at least initially since our insurance company is no longer contracted with Mayo; but I may have to consider returning to the migraine specialist despite the insurance issues. I live in the Orlando, Florida area; so there may be a migraine specialist in this area.  I will have to check into that. Again, thank you for responding promptly to my question.