[Hemiplegic migraine: from historical perspectives to current management].

Hemiplegic migraine is a rare subtype of migraine characterized by reversible hemiplegia/hemiparesis as an aura symptom. Visual, sensory, and/or speech symptoms typically accompany the motor aura, followed by throbbing headache. Because motor symptoms may last for up to several weeks, this unique clinical entity can markedly impair quality of life. Familial hemiplegic migraine is caused by autosomal dominant mutations in the CACNA1A, ATP1A2, SCN1A, and PRRT2 genes. These mutations are thought to induce neuronal hyperexcitability with resultant enhanced synaptic transmission and increased susceptibility to cortical spreading depolarization/depression. Therapeutic options remain limited, owing to the contraindication of triptans for acute treatment and the lack of established preventive therapies. However, recent evidence supports the potential efficacy of calcitonin gene-related peptide-targeting monoclonal antibodies.