No Role for Growth Hormone in Hemiplegic Migraine Treatment
There is no established role for growth hormone (GH) in the treatment of hemiplegic migraine based on current evidence and guidelines. The management of hemiplegic migraine focuses on conventional migraine therapies rather than hormonal interventions like growth hormone.
Understanding Hemiplegic Migraine
Hemiplegic migraine is a rare subtype of migraine with aura characterized by:
- Transient motor weakness/hemiparesis during attacks
- May include visual or sensory manifestations
- Can occur in familial (FHM) or sporadic (SHM) forms
- Associated with mutations in three genes (CACNA1A, ATP1A2, and SCN1A) that affect ion channels 1, 2
Current Treatment Approaches for Hemiplegic Migraine
Since hemiplegic migraine is rare, treatment recommendations are based on empirical data and clinical experience rather than large randomized controlled trials 1, 3. The established treatment options include:
Acute Treatment
- First-line: Acetaminophen and NSAIDs 1
- Triptans remain controversial in hemiplegic migraine but can be considered when common analgesics are insufficient 1
Preventive Treatment
When attack frequency exceeds 2 per month or attacks are severe, the following medications may be considered:
- Flunarizine
- Sodium valproate
- Lamotrigine
- Verapamil
- Acetazolamide
- Topiramate
- Candesartan
- Pizotifen 1
Beta-blockers like propranolol are more controversial in hemiplegic migraine but not absolutely contraindicated 1.
Growth Hormone and Migraine
The only evidence linking growth hormone to migraine comes from a small 1984 study that found:
- Some migrainous patients had high basal HGH levels
- Others showed hyperresponsiveness to clonidine (which stimulates HGH release)
- However, no correlation was found between HGH response and the prophylactic effect of clonidine on migraine 4
This limited, dated research does not support using growth hormone as a treatment for hemiplegic migraine.
Genetic Basis and Pathophysiology
Hemiplegic migraine has a clear genetic basis with identified mutations affecting ion transport proteins. The pathophysiology involves:
- Increased neurotransmitter and potassium ion levels at synaptic clefts
- Facilitation of cortical spreading depolarization (the phenomenon underlying migraine aura)
- Similar to typical migraine with aura but with a lower threshold and greater severity 3, 2
This pathophysiological understanding does not suggest a role for growth hormone in treatment.
Diagnostic Considerations
Diagnosis of hemiplegic migraine is based on:
- Clinical criteria from the International Classification of Headache Disorders (ICHD-3)
- Neurological examination during attacks
- Exclusion of other disorders (epilepsy, stroke, encephalitis)
- Genetic testing can confirm but not rule out the diagnosis 2
Important Cautions
When treating hemiplegic migraine:
- Conventional cerebral angiography is contraindicated as it may provoke an attack 1
- Patients with prolonged aura symptoms may require hospitalization 3
- New treatments should be approached with caution given the rarity of the condition and limited evidence 5
In conclusion, while ongoing research continues to explore novel therapeutic targets for migraine (such as CGRP antagonists), there is no evidence supporting growth hormone as a therapeutic option for hemiplegic migraine. Treatment should focus on established acute and preventive therapies based on individual patient characteristics and response.