The Difference Between Hemiplegic Migraines and Strokes

What is a Hemiplegic Migraine

A Hemiplegic Migraine Headache (HMH) is a rare but serious headache that can present with the same symptoms of a stroke. Hemiplegic headaches can cause muscle weakness so extreme it can cause temporary paralysis on one side of your head.

Before the actual headache, you may get symptoms that forewarn of the headache called Aura’s. An aura can start up tp two days prior to the actual headache.


Starts as a throbbing pounding heachache

Severe and usually starts on one side of your head and then moves to the other side

Nausea, vomiting, upset stomach

Loss of appetite

Pins and needles often starting in your hand and progressing up your arm and half of your face

Loss of balance and coordination

Sweating and/or chills

Blurred vision

Seeing double


Slurred speech

Sensitivity to light, sound and smell

Migraine Triggers:

Emotional stress

Sensitivity to specific chemicals in food such as cheese, alcohol, chocolate and fermented foods


Change in weather


Being over tired

Over exertion

Loud noises

Change in sleep patterns

Smoke, perfume

Hormonal changes


Your Doctor will take a detailed medical history asking questions such as, describing your pain, type and location of your headache. He will want to know how often you get migraines and if any activities or situations bring on your migraine. Also how did you feel before, during and after the headache.

Your Doctor will also do blood tests, a CT Scan or MRI to see if there are any neurological reasons you get migraines.


There are two main treatment options, one is called Abortive and the other is Preventative. Abortive medications are the most effective when you use them at the first sign of a migraine. Preventive medications are prescribed when the headaches are severe and occur more than four times a month and are interfering with your daily life and activities. Preventative medications reduce the frequency and severity and are taken on a regular basis.

Over the counter medications are good for mild to moderate migraines such as, Ibuprofen, aspirin, naproxen and coffee. Prescription medications such as steroid beta blockers, atenolol, antidepressants or anti-seizure medications.


Rest in a cool dark room

Put a cold compress on your neck

Massaging your scalp

Apply circular motion pressure to your temples



Make sure you get enough sleep

Eat regularly, don't skip meals


Maintain a healthy weight


Relaxation techniques

Migraines can be prevented by learning what your triggers are, following a healthy diet and exercise.

What is a stroke:

A stroke and Hemiplegic Migraine have similar symptoms but the one major difference is a migraine comes on gradually as compared to a stroke that comes on suddenly. A stroke can be deadly so you should know the signs,

F facial drooping

A arm weakness

S speech difficulties

T time to call 911

A stroke happens because your brain doesn’t get enough oxygen or blood to it and your brain is attacked by either a blockage or a clot. The initial symptoms of a stroke may be a slight headache with facial numbness or you can’t lift your arms.


Severe headache



Vision problems


Trouble walking or talking

Dizziness or slurred speech


Low or high blood pressure

The treatment for a stroke is taking blood thinners but if you had an acute ischemic stroke there is a drug called the “clot buster” which is a drug, TPA which must be administered within 3-4.5 hours after the initial onset.

A hemorrhagic stroke which is a ruptured blood vessel may require surgical removal of the blood clot or aneurysm. A Ischemic stroke is a clot lodged in a vessel in your brain.

Migraine VS Stroke:

- Migraines are severe, intense throbbing pain on one side of your head

- Migraine Auras disrupt visual, sensory, speech and motor or other central nervous system that precede a migraine

- Young people are usually afflicted with a migraine while with older people, a stroke is more likely

- A stroke is when your brain is attacked and occurs when a blood vessel in the brain is blocked, leaks or bursts which deprives the brain cells of oxygen causing them to die

- A migraine aura may resemble a transient ischemic attack

- With a Stroke, the symptoms are sudden while with migraines the symptoms are gradual

If you are not sure as to whether or not you have a Hemiplegic migraine or a stroke, you should always go to your ER immediately.