Clinical characteristics of hemiplegic migraine: a clinical study of 163 cases in a tertiary care headache centre.

Objective: Although population-based studies of hemiplegic migraine (HM) exist, large-scale clinic-based studies focusing on the detailed clinical characteristics of HM have not been reported. This study aims to define the clinical characteristics of HM in a tertiary care headache centre.

Methods: A retrospective analysis was conducted based on the medical records of HM patients.

Patients: This study included 163 consecutive HM patients who visited the National Hospital for Neurology and Neurosurgery between 2006 and 2013.

Results: According to the diagnostic criteria of International Classification of Headache Disorders (ICHD-3β), 142 patients were diagnosed with HM. Although 21 patients did not satisfy the diagnostic criteria, migrainous headaches with repetitive hemiparesis were reported and other disorders were excluded, hence these patients were clinically diagnosed with HM. The temporal progression of aura symptoms was atypical in 40 patients. The median duration of hemiparesis was 24 hours (interquartile range: 3-60 hours) which was far longer than that of previous population-based studies. The lifetime experience of an episode of motor aura exceeding 72 hours was reported in 51.6%. Hemiparesis was observed without full recovery in 9 patients (5.5%).

Conclusions: In many HM patients, the temporal progression of aura symptoms was diverse compared to typical descriptions in the literature, and the aura symptoms sustained longer than reported in the population-based study.