What have been your experiences with anti-CGRP therapies for hemiplegic migraine?

I think it is important to point out that true hemiplegic migraine is very rare. Many patients are incorrectly diagnosed with (sporadic) hemiplegic migraine, and actually have sensory aura or *MUMS. These patients can absolutely have CGRP-targeted medications.

In terms of true hemiplegic migraine, I ...

It is a great question because it highlights some of the most important "unknowns" when considering anti-CGRP therapies. I will begin with two anecdotes and then follow with the theoretical concerns. When the first CGRP receptor antibody came out, like most headache specialists, I turned to it for m...

In a small sample size, I have not noticed a difference in response to CGRP-blocking medications in patients with hemiplegic migraine vs migraine with other aura or migraine without aura. I have not seen a change in aura symptoms (worsening in aura symptoms) after starting CGRP blocking medications....

The fact that there are differences of opinion clearly tells us that there are many unknowns. One part of the question is about safety, which, of course, needs to come first. In true hemiplegic migraine (I think a minority of MUMS), especially if frequent, especially if associated with other stroke ...