Could You Diagnose This Man?

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.

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.