hemiplegic migraine

26 July 2018

Migraine Genetics: Research more sophisticated, treatment more complicated?

The genetic basis of migraine may be well known, but we have a lot to learn about how it all works. But recent research is giving us fascinating new insights.

This particular study came out in May and was published in the neuroscience journal, Neuron. Researchers were trying to understand just how migraine is passed on.

migraine genetic traits Basically, two models were investigated. First, Mendelian inheritance. This means that there are a very few genetic traits that are passed on. Depending on what is dominant, they basically predict if the person will inherit migraine or not. We see this in some types of hemiplegic migraine. This probably sounds a lot like what you learned in school about genetic traits.

Second, polygenic inheritance, also known as multifactorial inheritance. In this model, there are hundreds – maybe thousands – of genetic traits that work together. In certain combinations, the person may have migraine.

There’s a third possibility – that it’s really a combination of both. There are some major genetic traits working together with these many less-important traits.

So, for those still reading this article, you’ll be interested to know what the result was. Actually, it surprised the researchers.

First, it was found that the research at this stage is pointing mostly to polygenic inheritance. That is, there is a wide variety of common genetic factors that all work together to result in migraine. This article explains it as being dealt a hand of cards. It’s not the individual cards that make a difference, it’s the hand as a whole.

This was even the case in familial hemiplegic migraine, which has traditionally been the most specifically genetic migraine type according to the research.

This actually follows a lot of genetic research that is going on today. There are several conditions that were once thought to be a lot more clear-cut – from a few genetic factors – that we are now realizing are coming from a much more complex genetic basis.

Another interesting discovery was that different types of migraine do indeed have different – and complex – genetic backgrounds.

Don’t get the idea that we now have specific genetic profiles for every type of migraine. We’re a long way from that. What we can say, it that certain profiles do tend to mean you inherit migraine – but there are other profiles, still unknown, that may also lead to the same type of migraine.

So where does this leave us? We are finding that treating migraine, from a genetic standpoint, will rarely be a case of “altering” a gene or two, or targeting a simple function of a gene. It’s far more complex. This could mean that some treatment in the future will also need to be more complex. But there is a lot of study to be done.

If you want to get geeky and keep studying the topic, check out this article – New light on genetic foundation of migraines, and the study itself here – Common Variant Burden Contributes to the Familial Aggregation of Migraine in 1,589 Families

7 December 2017

Ocular Migraine Symptoms

James Information 0

Discussing ocular migraine symptoms can be frustrating because the term itself remains confusing. The International Headache Society has provided guidance in the diagnosis of migraine conditions and symptoms through their “International Classification of Headache Disorders”, which lists various types of headache and migraine disorders. But ocular migraine isn’t one of them.

Ocular Migraine Symptoms? So if your doctor is using the term, I would encourage them to refer to the classification system, which will help us all speak the same language!

Types of “Ocular Migraine”

Today, people who are talking about ocular migraine symptoms are typically referring to some type of migraine with aura (yes, there are many types!). But first let’s take a look at the warning symptoms, because visual symptoms can be a sign of various conditions. If you’re having vision problems, and any of the below describes you, see a doctor immediately.

Warning signs:

Visual symptoms last for less than 5 minutes.
Visual symptoms last more than an hour.
Symptom is primarily partial or complete blindness (as opposed to seeing flashing lights, etc).
You have recently had a stroke or brain injury.
The symptoms are new – this is especially a concern if you are over 40.

Even if none of the above is true, if these are new symptoms to you, you should see a doctor. Issues such as transient ischemic attack (TIA) (mini-stroke) and even stroke can closely mimic migraine. Your doctor will need to rule out other conditions before giving you a diagnosis.

Now you’re still experiencing ocular migraine symptoms, and you want to narrow down your diagnosis some more. This will help.

What type of migraine?

Are you experiencing “motor weakness” along with the visual symptoms? Motor or muscle weakness may be a sign that you’re suffering from a type of hemiplegic migraine.
Are you experiencing other strange symptoms, such as jerky movements, trouble speaking, trouble hearing, vertigo, double vision, or even a decreased level of consciousness? Some of these may be typical of migraine with aura, but they could indicate migraine with brainstem aura.
Is the aura strictly visual, and it’s happened several times? Do the visual symptoms always last between 5 minutes and 1 hour? And are they always in only one eye? If so, you may have retinal migraine.

If none of these fit you, you may have typical migraine with aura.

Now, you’ll notice I didn’t say a lot about headaches. Yes, it is common to have headaches along with retinal migraine – but it’s not always the case. It is possible to have retinal migraine attacks with no headache. It is also possible to have typical aura without headache, which is more common and can have more varied symptoms than the more specific retinal migraine.

Underneath many of these types of migraine, there are also sub-types.

If you’re wondering if it’s worth getting a specific diagnosis for your ocular migraine symptoms, it is. Some of these types of migraine have treatments that specifically work with that migraine type.

A neurologist with experience in migraine and headache conditions can help you find a diagnosis and a treatment.

The Mayo Clinic has a brief but helpful article on ocular migraine symptoms here.

Again, if these are new symptoms, you should go to a doctor who can help you rule out various other possibilities. Whether migraine or not, these can be serious and debilitating symptoms.

2 February 2017

The Early Stages of a new Hemiplegic Migraine Treatment

James Discoveries & Stats 1

Recent genetic research has identified some possible new treatments for hemiplegic migraine – treatments which may also work for other types of migraine in the future.

It may be much more exciting when a new treatment is just about to hit the market, but it’s worth noting the steps that many of these treatments have had to go through in order to get to your medicine cabinet. So this is one of those treatments that is still in the very early stages.

This study, based in Spain, received a research grant from the Migraine Research Foundation. The study was based around certain genetic mutations, in this case in the P/Q-type calcium channel (CaV2.1). These types of mutations have been linked to a number of disorders, including hemiplegic migraine. It is believed that the functional changes caused by these mutations may lead to the cortical spreading depression – a kind of brain storm that occurs in other types of migraine as well (a storm of activity that sometimes leads to the visual auras many migraine patients have experienced).

So if there is a dysfunction in this calcium channel, the question is – could we find a medication that could fix it? And, importantly, a targeted tool – a medication that won’t cause a bunch of other problems and make other unwanted changes at the same time.

In other words, we want laser surgery, not a dynamite blast.

Computer research The researchers started with a database of millions of compounds that interact with this calcium channel. Then they started narrowing things down. Would this compound do what we want? Would it likely cause major side effects? Is it even available? If available, is it too expensive to manufacture? And so on, and so on.

After this extensive research, the millions were narrowed down to 6 – yes, just six – six possible compounds that have a good chance to be treatments.

At this point, animal studies often follow to test general safety before a possible drug for humans is developed.

This is an amazing process that would not be available without our knowledge of genetics, international cooperation, and modern computers. And one more thing – funding. Thanks to those of you who have given to the Migraine Research Foundation, research like this is possible.

If a medication could be developed to stop the hyper-sensitivity of migraine, stopping the cortical spreading depression, it could drastically improve the lives of millions.

To donate to the Migraine Research Foundation, just visit this page.

14 November 2016

Could You Diagnose This Man?

James Discoveries & Stats 0

He comes into the emergency room, helped along by a friend because he’s having trouble walking. He’s confused, and can’t really understand what the doctors and nurses are saying. He’s having trouble talking.

When you can’t communicate, it’s pretty hard to make a good diagnosis. And problems communicating certainly can be a reality with migraine. Difficulty speaking and/or understanding speech is one of the possible symptoms.

If you had been in the emergency room when this man came in, you might have thought he was drunk. But he wasn’t. You might then realize that he was having trouble with one side of his body. Could it be a stroke? Possibly. He’s in his early 20s, so stroke is possible, though a little more unexpected.

Hemiplegic Migraine Emergency Eventually you find out from his friend that this has happened before, and that the man has a history of migraine. Could it be a migraine attack? It could, but you have to rule out some other things first. And if it is migraine – what kind? And what treatment would be best?

Hopefully you’re not suffering as this man is, and you’re not going to have the frustration the doctor has, because I’m going to tell you his condition. This man is suffering from an attack of hemiplegic migraine.

Hemiplegic migraine is rare, but it’s actually tricky to know just how common it is, because it’s misdiagnosed so often. MS? Epilepsy? A stroke? But in this case, no. One-sided paralysis, confusion, a feeling of “pins-and-needles” – all symptoms of hemiplegic migraine (HM).

This story is based on a real person. 24 years old, he suffered from repeated attacks of migraine since he was 4 years old. His symptoms were temporary, followed by extreme sleepiness. And researchers in Luxembourg and Belgium hope that his case will help others learn how to diagnose HM more quickly.

In a case report published last month, the suggestion was made that doctors consider HM when migraine symptoms are very unusual – that is, there is aura, but not only aura. The key in HM is motor weakness – weakness or paralysis on one side of the body. This might not always be the case, or might not even be noticed or remembered. But with the help of the patient and friends and family, the diagnosis can be helped along.

Another possible symptoms that they mentioned is a temporary encephalopathy, or changed mental state, brought on by mild trauma to the head.

Weakness, trouble thinking/talking, paralysis – these should be signs that the doctor should dig a little deeper. When HM is suspected, genetic testing is helpful. A full family medical history is also critical.

To read the whole article, see Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report. And remember – take migraine seriously, even if it takes some work to understand it.

4 August 2016

MUMS – Migraine and Arm Weakness

James Information 5

Migraine researchers are struggling with a type of migraine that is just starting to be understood, known as MUMS – that is, migraine with unilateral motor symptoms. One of the most unusual symptoms is a type of weakness in one arm.

MUMS has been connected in the past with hemiplegic migraine. That’s because the key symptom with hemiplegic migraine is a kind of temporary paralysis on one side of the body.

But there seems to be a group of migraine patients who fit or almost fit the description of hemiplegic migraine, and yet they have somewhat unique symptoms.

So what is the key symptom of MUMS? Every patients with MUMS has a kind of weakness or paralysis in one arm and/or hand. Commonly it’s a kind of weakness called “give-way” “give-away” “collapsing” weakness.

MUMS - migraine with unilateral motor symptoms

Give-way weakness is diagnosed when pushing on the arm is resisted, but the arm “gives-way” suddenly for no apparent reason.

Patients with MUMS also often suffer from dizziness, numbness, allodynia (painful/sensitive areas of the skin), visual aura and other visual problems, language problems, confusion, and pins and needles.

What makes things even more scary is that the arm weakness may continue even when patients are not in the middle of an actual migraine attack.

Some patients have been confused by the discussion around “give-way weakness” and “true weakness”. Some doctors seem to suggest that the weakness is somehow “imaginary”.

The fact is that, as with many migraine symptoms, no one is sure what is causing the weakness. It may be that it’s another symptom coming from activity in the brain, the same activity that seems to cause visual auras. It’s not voluntary or imaginary at all.

Because of some of the related symptoms, such as allodynia, the give-way weakness could also be a “protective” measure, to try to avoid the pain and discomfort of other symptoms (which can be quite severe and disabling in MUMS).

Whatever the case, experts are recognizing that MUMS is certainly a real and serious problem.

MUMS tends to show up later in life than hemiplegic migraine, usually in the patient’s 30s, as opposed to the 20s.

Many patients with MUMS, as with hemiplegic migraine, are initially told they’ve had a stroke. And MRI should clarify whether or not the symptoms are from stroke.

It’s very important to diagnose MUMS, because there are certain treatments that may be more successful with MUMS than with other types of migraine. For example, as with hemiplegic migraine, verapamil may help.

Of course any first-time symptoms like this should get you to emergency right away. Stroke should be diagnosed as soon as possible. If you do find out you have a type of migraine, early treatment is also very important.

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