Treatment for hemiplegic migraine

Five or six years ago my daughter (now 30) began having strange turns when she would lose consciousness and her right arm and sometimes right leg would shake. When she came round, she would be unable to speak, although able to understand language, and her right arm and sometimes leg would be paralysed; the after-effects could linger for hours or sometimes days. She was eventually diagnosed  as having hemiplegic migraine, and for the last four years she has been taking propranolol as a preventative medicine. However, the dose has had to be increased until she is now taking 160mg twice daily. She has given up eating cheese and chocolate, but has had more and more headaches, and a few weeks ago she had a full blown attack with seizures, over three days. Three weeks later she still has slight dysphasia. It seems obvious that propranolol is no longer working. Can you suggest what else she could try. In particular, would antidepressants help? (She has been offered these but has had bad side-effects in the past.)

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Hemiplegic migraines are typically treated the same as migraines except triptans are still contraindicated. It sounds like you are asking about preventative medications. There many options including beta blocker (i.e., propranolol), calcium channel blockers (such as verapamil), antiepileptics (e.g., topiramate), antidepressants, etc.

I would suggest that your daughter see a specialist in headache to discuss her symptoms further but also appropriate treatment options.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.