Basilar type migraine, also known as migraine with brainstem aura, is a rare subtype of migraine with aura that presents with symptoms originating from the brainstem or both cerebral hemispheres. It is characterized by specific brainstem symptoms such as vertigo, dysarthria, diplopia, and ataxia. In this article, we will explore the diagnostic criteria for basilar type migraine and discuss its presentation, etiology, treatment, and management options.
Key Takeaways:
- Basilar type migraine is a rare and specific subtype of migraine with aura.
- It presents with brainstem symptoms such as vertigo, dysarthria, diplopia, and ataxia.
- The exact cause of basilar type migraine is not known, but triggers and genetic factors may play a role.
- Diagnosis of basilar type migraine is based on specific criteria outlined in the International Classification of Headache Disorders.
- Treatment options include acute symptom relief and preventative measures, such as identifying triggers and using medications.
What is Basilar Type Migraine?
Basilar type migraine, also referred to as migraine with brainstem aura or basilar artery migraine, is a specific subtype of migraine with aura. It was first described by Bickerstaff in 1961 and has since been recognized as a distinct form of migraine. The term “basilar” comes from the belief that the condition was caused by a spasm of the basilar artery, but it is now understood to be related to the firing of nerves in the brainstem.
Brainstem aura symptoms include:
- Vertigo
- Dysarthria
- Diplopia
- Tinnitus
- Impaired hearing
- Lack of coordination
- Confusion
- Sometimes loss of consciousness
It is important to note that basilar type migraine is a reversible condition, and the symptoms typically resolve within a short period.
| Variants of Basilar Type Migraine | Description |
|---|---|
| Basilar artery migraine | A variant of basilar type migraine that specifically involves the basilar artery |
| Migraine with brainstem aura | Another term used to describe basilar type migraine due to the brainstem involvement in the aura symptoms |
Etiology and Triggers
The exact cause of basilar type migraine is not known, but it is believed to be multifactorial. Both genetic and environmental factors are thought to play a role.
Genetic Factors
While the genetic basis of basilar migraine is suggested, no definitive genetic linkage has been found yet. However, studies have observed a higher prevalence of basilar type migraine in individuals with a family history of migraine, suggesting a possible genetic component.
Environmental Triggers
Basilar type migraine can be triggered by various environmental factors. Identifying and avoiding these triggers can help prevent or minimize migraine attacks. Common triggers include:
- Strong smells
- Loud noises
- Weather changes
- Excessive or inadequate sleep
- Increased stress
- Intense physical exertion
- Oral contraceptives
- Certain foods
- Food preservatives
By understanding and managing these triggers, individuals with basilar type migraine can potentially reduce the frequency and severity of their migraines.
While the precise etiology of basilar type migraine remains elusive, ongoing research aims to uncover the underlying mechanisms and genetic associations. By identifying the factors contributing to this condition, healthcare professionals can develop more targeted and effective treatment strategies for individuals living with basilar type migraine.
Presentation and Symptoms
The presentation of basilar type migraine is characterized by brainstem aura symptoms. These symptoms can include:
- Vertigo: a sensation of spinning or dizziness.
- Dysarthria: difficulty speaking clearly or slurred speech.
- Diplopia: double vision.
- Ataxia: lack of coordination and balance.
- Tinnitus: ringing in the ears.
- Impaired hearing: reduced or distorted hearing.
- Confusion: disorientation or mental fog.
The most common symptom experienced is vertigo. Along with these brainstem symptoms, individuals with basilar type migraine may also have typical aura symptoms such as:
- Visual disturbances
- Paresthesia (tingling or numbness)
- Language problems
Following these aura symptoms, individuals often experience a severe occipital headache that can last for hours to days.
In addition to the brainstem aura symptoms, other typical migraine symptoms such as throbbing headache, sensitivity to light and sound, and nausea may also be present.
Diagnosis of Basilar Type Migraine
The diagnosis of basilar type migraine is based on specific criteria outlined in the International Classification of Headache Disorders. To be diagnosed with basilar type migraine, you must have experienced two or more attacks that fulfill the following aura symptoms:
- Dysarthria: Difficulty speaking clearly
- Vertigo: Sensation of spinning or dizziness
- Tinnitus: Ringing in the ears
- Hearing impairment: Decreased ability to hear
- Diplopia: Double vision
- Ataxia: Lack of coordination
- Decreased level of consciousness: Altered awareness or consciousness
- Bilateral paresthesia: Tingling or numbness on both sides of the body
- Completely reversible symptoms: All symptoms must resolve completely within a certain timeframe
Proper diagnosis is crucial in determining the most appropriate treatment plan and management strategies for basilar type migraine. If you suspect you have this condition, consult a healthcare professional for a thorough evaluation and diagnosis.
Evaluation and Differential Diagnosis
When diagnosing basilar type migraine, a comprehensive evaluation is essential to differentiate it from other conditions that may present with similar symptoms. Certain tests, such as brain imaging and EEG, can assist in this process.
Brain imaging techniques, such as MRI (Magnetic Resonance Imaging) or CT scan (Computed Tomography), may be performed to rule out other pathologies like stroke or tumors. These imaging techniques provide detailed images of the brain and can help exclude structural abnormalities that may be causing the symptoms.
In some cases, EEG (Electroencephalography) may be indicated to rule out seizures, particularly when there is confusion or decreased level of consciousness. EEG measures the electrical activity of the brain and can detect abnormal patterns associated with seizure activity.
It is also important to consider the differential diagnosis for basilar type migraine. This involves distinguishing it from other forms of migraine, as well as conditions such as Meniere’s disease, vestibular disease, transient ischemic attack (TIA), stroke, and other neurological disorders. Laboratory studies and brain imaging play a crucial role in differentiating these conditions and ensuring an accurate diagnosis.
Treatment and Management Options
The treatment and management of basilar type migraine involve both acute symptom relief during migraine attacks and preventative measures to reduce the frequency and severity of future episodes.
Acute Treatment
During a basilar type migraine attack, prompt relief of symptoms is essential. Acute treatment options include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen or naproxen sodium, can help alleviate pain and inflammation associated with migraines.
- Anti-emetics: Medications like metoclopramide or ondansetron can be used to reduce nausea and vomiting.
- Migraine-specific abortive therapies: These include medications like sumatriptan or rizatriptan, which target specific pathways involved in migraine attacks.
It is important to note that triptans and ergotamines have traditionally been avoided for basilar type migraine due to concerns about potential risks. Consult with your healthcare provider to determine the most appropriate acute treatment for your specific condition.
Preventive Therapy
Preventive therapy for basilar type migraine aims to reduce the frequency and severity of future episodes. It involves a combination of approaches:
- Identifying and modifying triggers: Keeping a headache diary can help identify triggers such as certain foods, stress, lack of sleep, or hormonal changes. By avoiding or minimizing exposure to triggers, the likelihood of migraine attacks may decrease.
- Medications: Your healthcare provider may prescribe medications to help prevent migraines, such as:
| Medication | Description |
|---|---|
| Verapamil | A calcium channel blocker that helps prevent basilar type migraine and other forms of migraine. |
| Topiramate | An antiepileptic drug that has been shown to reduce the frequency and severity of migraines. |
| Propranolol | A beta-blocker that can be effective in preventing migraines. |
Non-pharmacological therapies may also be effective as part of a comprehensive treatment plan. These include:
- Relaxation techniques: Practices such as deep breathing exercises, meditation, or yoga can help reduce stress and promote relaxation.
- Acupuncture: This traditional Chinese practice involves the insertion of thin needles into specific points on the body, which may help alleviate migraine symptoms.
- Massage: Massage therapy can help relax muscles and reduce tension, potentially easing migraine symptoms.
- Cognitive-behavioral therapy: This form of therapy focuses on identifying and changing thought patterns and behaviors that contribute to migraines.
- Biofeedback: Biofeedback techniques help individuals gain control over bodily functions such as heart rate and muscle tension, potentially reducing migraine frequency.
Prognosis and Complications
The prognosis for individuals with basilar type migraine varies but generally improves with age. The frequency of brainstem aura symptoms typically decreases over time, and the condition often evolves into more typical forms of migraine. While basilar type migraine is associated with more severe and longer-lasting symptoms compared to other types of migraine, it is generally non-life-threatening.
However, individuals with basilar type migraine may have a slightly higher risk of stroke compared to migraine without aura. Smoking and the use of estrogen contraceptives further increase the risk of stroke in individuals with migraines, so risk factor modification is essential.
To summarize:
- The prognosis for basilar type migraine generally improves with age
- Frequency of brainstem aura symptoms decreases over time
- Basilar type migraine is generally non-life-threatening
- Individuals with basilar type migraine have a slightly higher risk of stroke
- Smoking and estrogen contraceptives increase the risk of stroke in individuals with migraines
Comparison of Risk Factors for Stroke in Basilar Type Migraine
| Risk Factors | Basilar Type Migraine | Migraine Without Aura |
|---|---|---|
| Increased risk of stroke | ✓ | |
| Smoking | ✓ | |
| Estrogen contraceptive use | ✓ |
Understanding the prognosis and potential complications of basilar type migraine is crucial for effective management and risk reduction. While the condition is generally non-life-threatening, the increased risk of stroke emphasizes the importance of risk factor modification, particularly in individuals who smoke or use estrogen contraceptives. By addressing these factors and working closely with healthcare professionals, individuals with basilar type migraine can better manage their condition and reduce the risk of potential complications.
Conclusion
Basilar type migraine, also known as migraine with brainstem aura, is a rare subtype of migraine with aura that presents with specific brainstem symptoms such as vertigo, dysarthria, diplopia, and ataxia. While the exact cause of basilar type migraine is unknown, it is believed to be influenced by triggers and genetic factors. Diagnosing this condition requires meeting specific criteria and ruling out other potential causes through a comprehensive evaluation.
Treatment and management options for basilar type migraine include both acute symptom relief and preventative measures. Acute treatment focuses on providing relief during migraine attacks, while preventative therapy aims to reduce the frequency and severity of future episodes. It is important to note that basilar type migraine is generally non-life-threatening, although individuals may have a slightly higher risk of stroke.
Understanding the diagnostic criteria and effectively managing basilar type migraine can significantly improve outcomes and enhance the quality of life for individuals with this condition. By implementing appropriate treatment strategies and identifying and modifying triggers, people with basilar type migraine can effectively manage their symptoms and reduce the impact of this rare form of migraine.
FAQ
What is basilar type migraine?
Basilar type migraine, also known as migraine with brainstem aura, is a subtype of migraine with aura that presents with symptoms originating from the brainstem or both cerebral hemispheres.
What are the symptoms of basilar type migraine?
The symptoms of basilar type migraine include brainstem aura symptoms such as vertigo, dysarthria, diplopia, ataxia, tinnitus, impaired hearing, lack of coordination, confusion, and sometimes loss of consciousness.
How is basilar type migraine diagnosed?
Basilar type migraine is diagnosed based on specific criteria outlined in the International Classification of Headache Disorders. The criteria include the presence of two or more attacks that fulfill specific aura symptoms followed by a migraine without aura or occurring within one hour of a migraine without aura.
What are the treatment options for basilar type migraine?
Treatment options for basilar type migraine include acute symptom relief during migraine attacks using nonsteroidal anti-inflammatory drugs (NSAIDs), anti-emetics, and migraine-specific abortive therapies. Preventive therapy may involve identifying and modifying triggers, keeping a headache diary, and considering medications such as verapamil, topiramate, or propranolol. Non-pharmacological therapies like relaxation techniques, acupuncture, massage, cognitive-behavioral therapy, and biofeedback may also be helpful in preventing migraine attacks.
What is the prognosis for individuals with basilar type migraine?
The prognosis for individuals with basilar type migraine varies but generally improves with age. The frequency of brainstem aura symptoms typically decreases over time, and the condition often evolves into more typical forms of migraine. While basilar type migraine is generally non-life-threatening, individuals may have a slightly higher risk of stroke compared to migraine without aura.
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