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Hemiplegic migraine is a rare form of migraine with aura that includes reversible motor weakness. Objective: to describe a case of a patient with hemiplegic migraine, highlighting its importance as a differential diagnosis in the emergency department. Case report: Female patient, 55 years old, admitted to the emergency department with holocranial headache associated aphasia, without motor deficit. History of recurrent episodes of headache in childhood and adolescence. Stable vital signs, clinical examination was normal. Skull CT was requested, with no changes. Admitted to investigation with spontaneous return of speech and improvement of headache on the fifth day. She returned one week later with similar symptoms now associated with left hemiplegia, no changes in the new CT scan of the skull nor the other complementary exams with spontaneous improvement on the third day. She repeated the same symptoms two months after the last episode when the diagnostic hypothesis of hemiplegic migraine was suggested. She was discharged with topiramate and amitriptyline and sent to the neurology clinic. Discussion: headache is one of the most frequent symptoms in emergency rooms, accounting for 1-4 % in emergency units. Keeping in mind the differential diagnoses can be a crucial factor for the patient's prognosis.

Migrânea hemiplégica: diagnóstico diferencial pouco conhecido em emergência / Hemiplegic migraine: differential diagnosis not known in emergency