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The weakness that characterizes hemiplegic migraine is a manifestation of motor aura. The aura of hemiplegic migraine is most probably caused by cortical spreading depression, a self-propagating wave of neuronal and glial depolarization that spreads across the cerebral cortex.
Migraine most frequently causes simple visual hallucinations, but complex visual hallucinations may occur in basilar migraine and familial hemiplegic migraine. In contrast to hallucinations in migraine aura, complex visual hallucinations in basilar migraine appear at a late stage of an attack usually following symptoms of brainstem and cerebellar dysfunction or at recovery from coma.