Hemiplegic migraine
A rare type of severe migraine involving temporary weakness or paralysis on one side of the body
What is hemiplegic migraine?
Hemiplegic migraine is a rare type of severe migraine involving temporary weakness or paralysis on one side of the body. This usually happens alongside other migraine symptoms.
Symptoms of hemiplegic migraine
Everyone experiences migraine differently and your symptoms may not completely fit one type of migraine. The key difference in the symptoms of hemiplegic migraine, compared with other forms of migraine, is severe temporary weakness or inability to move (paralysis) on one side of the body as part of an attack. Many people describe that they become unable to move one arm and one leg from the same half of the body or that it is very hard to move them.
Hemiplegic migraine or stroke?
Hemiplegic migraine attack symptoms can look like those of a stroke or transient ischaemic attack (TIA). However, hemiplegic migraine attack symptoms tend to start more gradually. If you are unsure which you are having, you should always seek medical help immediately. It’s important to be treated as soon as possible if you are having a stroke or a TIA. It may be worth visiting A&E to be safe, and you can also call the NHS helpline by dialling 111 if you are not sure what to do.
If you want to learn more about stroke, the Stroke Association website has more information and a dedicated helpline.
Hemiplegic migraine is a type of migraine with aura. This means you may experience a range of symptoms alongside physical weakness or paralysis during attacks. Common symptoms include headache, feeling or being sick, and sensitivity to light, sound or smells.
Other symptoms of migraine include:
- eyesight changes, including seeing coloured spots, zigzag patterns or sparkles
- difficulty with or changes to speech, such as slurring words, not being able to speak clearly or knowing what you want to say but not being able to get the right words out
- pain caused by light (photic allodynia)
- difficulty reading, listening and writing
- hearing problems or ringing sounds in the ears
- confusion
- a feeling of movement, spinning or swaying (vertigo)
- numbness, tingling or vibration
- sensitivity to touch on the head or face (cranial allodynia)
The stages of a hemiplegic migraine attack are like those for other types of migraine. This usually includes a prodrome “warning” stage, an aura stage, a main attack stage and a postdrome “recovery” stage. For many people symptoms appear gradually, one at a time, over a period of 20 to 30 minutes. It can take a few days or longer to feel normal again after a migraine attack.
People with hemiplegic migraine might not experience weakness, paralysis or other aura symptoms with every migraine attack they have. You might experience hemiplegic symptoms only once, then have different symptoms in future or never experience a migraine attack again. On average, hemiplegic migraine attacks occur less often and become less severe as you get older, but this isn’t the case for everyone.
Diagnosis of hemiplegic migraine
If you’re experiencing hemiplegic migraine symptoms for the first time, you should seek medical help immediately in case you are having a stroke or a TIA. If you are not sure what to do, call the NHS helpline by dialling 111 or visit A&E.
Once you have confirmed that the symptoms are not caused by a stroke or a TIA, you should visit your doctor to rule out other conditions and create a treatment plan. Your doctor can discuss your symptoms with you, as well as other health conditions and your family history. They may also refer you to a specialist at a headache clinic for further tests or treatments.
The International Classification of Headache Disorders (3rd edition) criteria for hemiplegic migraine diagnosis includes at least two attacks with temporary weakness or paralysis, as well as visual, sensory and/or language symptoms. There are also criteria relating to the timescale and type of symptoms you experience. The full criteria are available on the ICHD website.
There are two types of hemiplegic migraine:
Familial hemiplegic migraine, or FHM, is the genetic form that can be inherited. Around half of children who have a parent with hemiplegic migraine will also show symptoms at some point in their life. Scientists have discovered that this is linked to three gene mutations, CACNA1A, ATP1A2 and SCN1A. Gene mutations are differences in the instructions that tell your body how to work. They can have a positive or negative effect, or no effect at all. These three gene mutations sometimes cause the channels in your nerve cells to work incorrectly, which can lead to a hemiplegic migraine attack. Not everyone diagnosed with FHM has these exact gene mutations.
Sporadic hemiplegic migraine, or SHM, is the non-genetic form of hemiplegic migraine. SHM is diagnosed when someone has hemiplegic migraine symptoms but no one else in their immediate family does. The cause of SHM is thought to be new random gene mutations that have not been inherited.
Treatment options for hemiplegic migraine
Your doctor or specialist will discuss treatments for hemiplegic migraine with you, considering your symptoms and medical history. Generally, the treatment is similar to that for other types of migraine. Treatment might include preventive or acute (rescue) medications, lifestyle changes or other non-medication based options like acupuncture, supplements or medical devices.
You are likely to be prescribed preventive medications for hemiplegic migraine if you are experiencing attacks regularly or have experienced symptoms several times. These aim to reduce how bad your attacks are and how often they happen. Medication options might include amitriptyline, propranolol, candesartan, topiramate, Calcitonin Gene-Related Peptide monoclonal antibodies (CGRP mAbs), gepants or flunarizine. CGRP mAbs and flunarizine are not available through your doctor but can be prescribed by a headache specialist. Greater occipital nerve blocks may also be offered by a specialist. For some of these options, you may need to show that you have tried other types of preventive medication first, but this requirement can be different depending on where you live.
If you get a headache as part of your symptoms, the recommended acute medications are the same as those for other types of migraine. Take any acute medications as a migraine attack starts, as this is when they are most effective. Options include traditional painkillers, such as ibuprofen, aspirin and paracetamol, and migraine-specific medications, such as gepants and triptans.
Triptans are thought to work partly by narrowing the blood vessels (vasoconstriction) to prevent migraine attacks. It was previously thought that vasoconstriction made aura symptoms worse and increased people’s risk of stroke, so triptans weren’t prescribed for people with hemiplegic migraine. However, recent evidence has shown that aura is caused by a wave of altered brain activity called cortical spreading depression, not vasoconstriction. Due to this, triptans are now considered a safe and effective treatment option in patients with migraine with aura without other vascular risk factors. Risk factors include smoking, use of certain types of contraception, and diagnosed hypertension, diabetes or vascular familiar hypercholesterolaemia. There is limited evidence about triptan use for hemiplegic migraine because it is a rare condition, but your specialist may recommend a triptan depending on your medical history.
Avoid painkillers containing opioids, such as codeine, where possible. This is because they can make you feel sick, be addictive and increase your risk of developing medication overuse headache.
If you feel sick or are sick as part of your migraine attack, anti-sickness (anti-emetic) medications like metoclopramide may also be prescribed.
Non-medication treatment options can improve symptoms when used alongside medication. They might also be useful if you are unable to (or prefer not to) take medication.
Lifestyle habits such as stress management, getting regular sleep, eating well and being physically active can improve symptoms and reduce how often you get attacks. Visit our Managing Your Migraine section for more advice on these topics. Your doctor can also discuss options such as supplements, acupuncture and migraine devices with you. Unfortunately, these are not usually available on the NHS and can be expensive.
Living with hemiplegic migraine
Coping during a hemiplegic migraine attack
Hemiplegic migraine attacks can feel frightening and difficult to manage, especially if they happen outside of the home or when you are alone. Depending on your individual symptoms, you might need different things during a hemiplegic attack. Many people find that resting in a dark, quiet room helps symptoms to improve. You might also find that cold compresses or heat packs help to manage pain and muscle tension. Like with other forms of migraine, it’s important to take any pain-relieving rescue medicines as soon as possible, as this is when they will work best.
Preparing for a hemiplegic migraine attack
Communication
If communication is difficult during an attack, it may be useful to prepare an emergency care statement ahead of time. This could include your name, emergency contact details and information about what you might need during an attack. Cards are available to buy online from various retailers and can be displayed on sunflower lanyards to show that you have a health condition. Alternatively, you could just use a piece of paper that you keep on you when you leave the house, or a note saved to your phone.
When you first start experiencing symptoms of an attack, ensure that the information will still be accessible while your muscles are weakened. You can then pass the information to someone you know, a member of the public or a healthcare professional if speaking becomes difficult.
Driving
You should not drive at all during a hemiplegic migraine attack. If you are driving and can feel one coming on, you should pull over as soon as you can. If you drive regularly, it may be worth making a plan ahead of time for what you would do if this happened. This could include keeping the details of your emergency contact somewhere accessible in your car or researching local taxi companies to help you get home safely.
If you live in England, Scotland or Wales you can contact the DVLA Medical Enquiries team for guidance on driving with migraine. If you live in Northern Ireland you must contact the DVA if you’ve had or currently have a medical condition that may affect your driving.
Mental health and wellbeing
Hemiplegic migraine can have a huge impact on many parts of daily life, including your mental health, relationships, education and work. Attacks can be very frightening and debilitating, so many people report feeling anxious or upset about future attacks even when they are feeling well. It can also be challenging to find appropriate treatment, and you may have spent years trying to make your migraine manageable.
If you or someone you know needs it, support is available. Our Support Services team are available by phone, live chat or email and offer free, confidential information and support for everyone affected by migraine. You can also talk to your GP about any concerns you have about your mental health and wellbeing.
Living with hemiplegic migraine
About our information
This information has been written by The Migraine Trust Information and Support Services team. It has been reviewed by our panel of expert health professionals and people affected by migraine.
Our information has been awarded the PIF TICK quality mark for trustworthy health information.
If you have feedback on our information, please get in touch at: feedback@migrainetrust.org
References for our information are available on request.
Last reviewed: October 2026 | Next review due: October 2029
- Zielke T. Identification of copy number variations in familial hemiplegic migraine genes in suspected hemiplegic migraine patients. Biomedicines. 2026;14(5):954
- Lipton RB. Characterizing the patient experience during the prodrome phase of migraine: A qualitative study of symptoms and their timing. Headache. 2025;65(8):1355-1368
- Artto V. Treatment of hemiplegic migraine with triptans. Eur J Neurol. 2007;14(9):1053-1056
- 2.3 Hemiplegic migraine – ICHD-3. Accessed 27 October 2026. https://ichd-3.org/
- di Stefano V. Diagnostic and therapeutic aspects of hemiplegic migraine. J Neurol Neurosurg Psychiatry. 2020;91(7):764-771
- Kumar A, Samanta D, Emmady PD, Arora R. Hemiplegic migraine. StatPearls. Published online 4 July 2023. Accessed 27 October 2026
- Scenario: Adults | Management | Migraine | CKS | NICE. Accessed 27 October 2026. https://cks.nice.org.uk
