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The Beyond Pain Foundation

Migraine types we support

Migraine guide

Hemiplegic migraine

Hemiplegic migraine is a rare type of migraine with aura in which the aura includes weakness on one side of the body. Because it can look exactly like a stroke, it needs to be diagnosed by a specialist, and some common migraine medicines may not be suitable.

How common
Rare
Weakness usually lasts
Under 24 hours
Chance a child inherits familial type
About 1 in 2
Who should diagnose it
A specialist

This guide is general information, not medical advice. Medicines and treatments must be prescribed or recommended for you by a doctor or pharmacist. We do not give doses here.

Related guides: Migraine with aura, Migraine with brainstem aura, Migraine, aura and stroke.

What it is

In hemiplegic migraine, the aura includes temporary weakness or paralysis of the face, arm or leg on one side, along with other aura symptoms such as changes to sight, numbness or speech. The weakness fully recovers.

Familial hemiplegic migraine

At least one close relative also has attacks with one-sided weakness. It's caused by changes in genes that control signalling in nerve cells, and each child of an affected parent has about a 1 in 2 chance of inheriting it.

Sporadic hemiplegic migraine

The same symptoms with no affected relative, probably because of a new gene change in that person.

Symptoms

  • Weakness on one side of the face, arm or leg
  • Visual aura, numbness, tingling or difficulty speaking
  • Confusion, vertigo, poor coordination, ringing in the ears
  • Headache before, during or after the weakness, or none at all
  • Rarely, drowsiness or reduced consciousness

How long it lasts

The weakness can last from about an hour to several days, but for most people it settles within 24 hours. Rarely it lasts longer. People usually recover fully between attacks. Attacks often start in childhood or the teenage years.

Diagnosis

A specialist makes the diagnosis from your history, usually after at least two attacks, once stroke, epilepsy and other causes have been ruled out, often with a brain scan. Genetic testing is available through specialist services but isn't always needed.

Treatment

Treatment should be guided by a specialist. The licences for triptans say they should not be used in hemiplegic migraine. Never take one during the aura, and only take one at all if your specialist has advised it. Simple painkillers and anti-sickness medicine are usually used for attacks. Preventive options include topiramate, which must not be used in pregnancy, and flunarizine, a medicine that's harder to get in the UK.

Carry information about your diagnosis

Hemiplegic migraine can be mistaken for a stroke by people who don't know you. A card or letter from your specialist explaining your condition can help in an emergency, but if symptoms are different from usual, always treat them as a possible stroke.

When to get urgent help

One-sided weakness for the first time must always be treated as a possible stroke. Call 999.

Call 999 if you have

  • weakness, numbness or a drooping face on one side for the first time
  • symptoms that are different from your usual attacks
  • drowsiness, confusion or a seizure (fit)
  • a sudden, extremely bad headache

Call NHS 111 if

  • an attack lasts longer than usual
  • you're unsure whether symptoms are your usual pattern

See your GP if

  • attacks are becoming more frequent
  • you haven't seen a specialist about your diagnosis

Work and your workspace

Migraine can count as a disability under the Equality Act 2010 (the Disability Discrimination Act in Northern Ireland) if it has a substantial, long-term effect on your everyday life. Conditions that come and go still count, and the law looks at how you would be without treatment. If it applies, your employer must make reasonable adjustments.

Adjustments that often help

  • An agreed plan for what happens if an attack starts at work
  • Not driving or using machinery during or after an attack
  • Working from home and flexible hours
  • Time off for specialist appointments
  • Flexibility over absence

A migraine-friendly workspace

  • A chair with good lumbar and neck support
  • A desk big enough to put your screen at arm's length
  • Screen raised so the top is at eye level
  • A flicker-free monitor with an anti-glare or blue-light filter
  • Lighting without flicker or glare, and blinds to control daylight

Access to Work can pay towards equipment and support. Acas and Citizens Advice give free advice on your rights.

How The Beyond Pain Foundation can help

If NHS waits are too long, or the help you need is not available to you on the NHS, we may be able to fund:

  • A private consultation with a specialist in hemiplegic migraine
  • Travel to a specialist centre
  • Home-working equipment so you can work safely from home
  • Support to agree a safe working plan with your employer

Every award depends on your situation and the funds we have that month. A letter from your doctor, a headache diary and a written quote all help your application.

Apply for funding Check the requirements

Support and sources

The Migraine Trust

Information and support service

Information on every type of migraine, a free information and support service, and advice on treatment and work.

migrainetrust.org

National Migraine Centre

Charity headache clinic

Specialist appointments in person and online, including routine appointments for a voluntary donation, plus free factsheets.

nationalmigrainecentre.org.uk
Sources for this guide

Written in our own words from the sources above. Last reviewed: October 2026. Figures can differ between sources; where they do, we give the range.