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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.
The primary feature that separates hemiplegic migraine from other types of migraine with aura is the presence of motor weakness as a manifestation of aura in at least some attacks. Migraine auras most often manifest as visual disturbances, but can also involve sensory, verbal, and rarely motor disturbances.