Hemiplegic Migraine Aura Alleviated by OnabotulinumtoxinA Injections

Investigators examined the effect of onabotulinumtoxinA on aura frequency and severity in patients with hemiplegic migraine.

OnabotulinumtoxinA, a preventative medication option for migraine headaches, may also be effective in managing the accompanying aura in hemiplegic migraine, according to a retrospective case series published in Headache

The study investigators identified 34 patients seen in the neurology department at Mayo Clinic who had been diagnosed with hemiplegic migraine and received OnabotulinumtoxinA injections on at least one occasion. The study cohort was narrowed down to 11 patients. Patients selected for the study were required to have thorough medical documentation on file for review.  A retrospective analysis of these cases was conducted. 

Of these patients, 4 had familial hemiplegic migraine, 7 had sporadic hemiplegic migraine; 10 of the patients had chronic migraine and 9 experienced motor auras at least once weekly.

The results showed that onabotulinumtoxinA administration reduced the frequency, severity, and/or duration of migraine aura in 9 patients. Of these patients, 6 reported that the medication wore off approximately two-thirds of the way through the first round of treatment. However, subsequent rounds of treatment resulted in improved outcomes. 

The study was limited by its retrospective design; only details from the medical record could be used and confounding variables were present but not addressed in the study design. 

Related Articles

“Within the limits of a retrospective review on a highly specific disorder, our series, combined with 2 other reported cases, suggests that [ onabotulinumtoxinA] may be another treatment to consider in patients with hemiplegic migraine,” the investigators wrote. “In the future, prospective studies on the usefulness of [onabotulinumtoxinA] for [hemiplegic migraine] would be helpful, with follow-up interviews specifically addressing the effect of [onabotulinumtoxinA] on the aura frequency, severity, and duration.”


Chen TY, Garza I, Dodick DW, et al. The effect of onabotulinumtoxinA on aura frequency and severity in patients with hemiplegic migraine: Case series of 11 patients [published online May 15, 2018].  Headache.  doi.org/10.1111/head.13317