1.2.3 Hemiplegic[^1] migraine

Female patient, 28 years old, medical student.

Clinical History:
The patient reports recurrent episodes of intense, unilateral, and pulsatile headache associated with focal neurological symptoms. The episodes began at age 16, with a frequency of 2 to 3 attacks per year. During the attacks, she experiences progressive muscle weakness on the right side of the body, which starts with tingling in the right arm and evolves into hemiparesis in approximately 20 minutes. The weakness can last up to 24 hours, but there have been episodes lasting 48 hours. Associated with the weakness, she reports visual aura with scintillating scotomas and difficulty speaking (expressive aphasia). The pulsatile headache begins after the neurological symptoms and is accompanied by photophobia, phonophobia, and nausea. The patient has been hospitalized on two occasions for stroke investigation, but imaging tests (CT and MRI of the brain) were normal.