Migraine with brainstem aura occurs in 1 in 10 people who get migraine with typical visual aura. Brainstem migraine is also called
- Basilar artery migraine
- Basilar-type migraine
- Bickerstaff migraine (named after Edwin R Bickerstaff who first identified the condition in 1961)
- Migraine with brainstem aura
- Vertebrobasilar migraine
What causes a brainstem migraine?
The exact underlying cause of brainstem migraine is not well understood, but researchers believe migraine is a complex disorder that is influenced by a combination of genetic, lifestyle, and environmental factors.
Brainstem migraines are more prevalent in adolescents and young females, although newer studies suggest that they can affect people of all ages.
Brainstem migraines are a strange phenomenon with unusual symptoms. These migraines usually start in the brainstem, occipital cortex, and cerebellum and are preceded by an aura. An aura is a group of sensory, visual, and motor changes that some people with migraine experience before a migraine attack as a warning sign.
It is believed that brainstem migraines occur due to vasoconstriction (narrowing of blood vessels) due to the spasm of the muscular wall of the basilar artery, leading to constricted blood flow. The nerves rather than the blood vessels are the cause of aura in brainstem migraine as opposed to other migraine types.
Risk factors that have been attributed to brainstem migraine attacks include:
- Physical or emotional stress
- Lack of sleep or excessive sleep
- Poor posture
- Motion sickness
- Dietary nitrites
- Being overweight or obese
- Bright or flashing lights
- Blood pressure medications
- Medication overuse
- Hormonal contraceptives
- Hormone fluctuations (during menstruation, pregnancy, or menopause)
- Strong smells (cologne, perfumes)
- Weather changes
What are symptoms of a brainstem migraine?
Brainstem migraine symptoms may include:
- Pain on one or both sides of the head
- Vertigo (a sensation of movement)
- Lack of coordination
- Slurred speech (dysarthria)
- Double vision (diplopia)
- Temporary loss of hearing
- Ringing in the ears (tinnitus)
- Loss of muscle control
- Loss of consciousness (syncope)
- Unsteadiness when walking (ataxia)
Aura symptoms may include:
How are brainstem migraines diagnosed?
A clinical diagnosis is essential to distinguish between a brainstem migraine and other brain disorders. The International Classification of Headache Disorders (ICHD) 3rd edition recommends the following diagnostic criteria:
- At least two migraine attacks with:
- Aura, consisting of temporary visual, sensory, or speech symptoms but without motor or retinal symptoms
- At least two of the following symptoms:
- At least two of the following characteristics:
- Minimum of one aura symptom over 5 minutes
- Two or more aura symptoms occur in succession
- Aura symptoms lasting 5-60 minutes
- One aura symptom is unilateral
- Aura is followed by a headache
- Transient ischemic attack, seizures, and other similar diagnoses have been ruled out through electroencephalogram, magnetic resonance imaging scan, or computed tomography scan
What other conditions can mimic a brainstem migraine?
Brainstem migraines may closely resemble familial hemiplegic migraines. The distinguishing feature is that hemiplegic migraines present with weakness on one side of the body and trouble speaking.
Other conditions that may mimic a brainstem migraine include:
How do you stop brainstem migraines?
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Acetaminophen, ibuprofen naproxen
- Anti-seizure medications: Valproic acid, topiramate
- Antidepressants: Amitriptyline, nortriptyline, doxepin, venlafaxine, duloxetine
- Blood pressure medications: Beta-blockers (atenolol, propranolol, nadolol), calcium channel blockers (verapamil)
- Triptans: Sumatriptan, zolmitriptan, naratriptan
- Anti-nausea medications: Dramamine
- Preventive strategies
The Migraine Trust. Migraine with brainstem aura. https://migrainetrust.org/understand-migraine/types-of-migraine/migraine-with-brainstem-aura/#page-section-5
American Migraine Foundation. Migraine with Brainstem Aura. https://americanmigrainefoundation.org/resource-library/migraine-with-brainstem-aura/
Bruce DF. Basilar Artery Migraines. WebMD. https://www.webmd.com/migraines-headaches/basilar-artery-migraines-causes-symptoms-tests-and-treatments
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What Causes Migraines?A migraine is a complex disorder that involves episodes of recurrent and severe headaches. An episode of a migraine can be very painful, lasting for hours, making day-to-day activities difficult until the episode is resolved. The frequency and severity of migraine attacks tend to decline with age. And women are more likely to suffer from migraines than men.
What Is the Best Cure for Migraine?The best cure for migraine involves preventive medications and lifestyle changes. Some newer medications and therapies are effective in controlling the symptoms of migraine. Avoiding or controlling triggers may provide considerable benefit. Migraine can be prevented mainly by using medications, avoiding triggers and implementing lifestyle changes.
What Is the Best Thing to Do for a Migraine?There is no permanent cure for migraine headaches, but there are migraine treatments that can prevent attacks and relieve symptoms. When you get migraines, you can ease the pain immediately by simple measures such as resting with your eyes closed in a dark, quiet room, putting an ice pack on your forehead, and staying hydrated by drinking plenty of liquids.
What Is the Most Common Type of Migraine?The most common type of migraine is migraine without aura (common migraine). 70-90% of people with migraine experience this type. The frequency of this type of migraine may range from once a year to several times per week.
Why Do I Get Constant Migraines?Constant migraines are known as chronic migraines. These are migraine headaches that last for 15 days or more for three consecutive months. Learn the four common causes and ten possible triggers for constant migraines.