1.2.3 Hemiplegic migraine

Description:
Migraine with aura including motor weakness.

Diagnostic criteria:
A. At least two attacks fulfilling criteria B and C
B. Aura consisting of both of the following:

    1. fully reversible motor weakness
    2. fully reversible visual, sensory and/or speech/language symptoms

C. At least two of the following four characteristics:

    1. at least one aura symptom spreads gradually over ≥5 min, and/or two or more symptoms occur in succession
    2. each individual non-motor aura symptom lasts 5-60 min, and motor symptoms last <72 hr2
    3. at least one aura symptom is unilateral3
    4. the aura is accompanied, or followed within 60 min, by headache

D. Not better accounted for by another ICHD-3 diagnosis, and transient ischaemic attack and stroke have been excluded.

Notes:
1. The term plegic means paralysis in most languages, but most attacks are characterized by motor weakness.

2. In some patients, motor weakness may last weeks.

3. Aphasia is always regarded as a unilateral symptom; dysarthria may or may not be.

Comment:
It may be difficult to distinguish weakness from sensory loss.