A migraine with predominant brainstem aura symptoms is known as a basilar migraine. Bickerstaff first described it in 1961. Other names for it are basilar artery migraine, basilar-type migraine, brainstem migraine, vertebrobasilar migraine, and Bickerstaff migraine. It was named basilar migraine because it was thought to be caused by spasm of the basilar artery. However, there is no proven evidence of vascular pathology for a basilar migraine, and it is now believed to be due to the firing of nerves in the brainstem.
The cause is unknown, but these migraines may be the result of a blood vessel that’s become tightened. This is called vasoconstriction, and it’s often caused by the muscles around your arteries becoming too tight and blocking blood flow.
Other possible causes are tortuous blood vessels, which have repeated twists and turns, and certain conditions that make it difficult for your brain to get enough blood.
Basilar migraines are considered a type of migraine with aura. This means the migraine can have symptoms that affect your senses, especially your sight. With this kind of migraine, you might see spots or lines in your vision as well as abnormal flashes of lights. During these disturbances or soon after, you get a bad headache. About one-fourth of all migraine patients experience typical aura symptoms. Migraine with brainstem aura (a basilar migraine) is a rare subtype of a migraine with aura that presents with symptoms originating from the brainstem or both cerebral hemispheres at the same time.
Because this type of migraine starts in your brainstem, you may also have some symptoms on one side or both sides of your body.
Basilar migraines are relatively rare. They usually last for only an hour or so. Severe basilar migraines may last for a few hours, but they’re not usually a result of any serious condition. With treatment and an understanding of what can cause them, they can be managed without interrupting your daily life.
This type of migraine can last anywhere from 4 to 72 hours. And it takes time to recover from one. You may feel drained for up to 24 hours after it’s over.
Symptoms and signs
Basilar migraines have a variety of specific symptoms, but also share symptoms with other aura migraines.
Symptoms specific to a basilar migraine include:
- Slurred speech
- Space occupying lesion of the brain (malignant tumor, hematoma, abscess)
- Loss of muscle control
- Cold hands or feet
- Difficulty hearing (hypacusis)
- Loss of balance or lack of coordination (ataxia)
- Blacking out or fainting
- Numbness in face, head, and hands
- Temporary blindness
- Difficulty speaking or slurred speech (dysarthria)
- Ringing in the ears
- Loss of balance or lack of coordination (ataxia)
- Extreme dizziness
- A sense that the room is spinning, making it difficult to stand
- Hemiplegic migraine
- Double vision
- Nausea or vomiting
- Temporary blindness
- Vertebrobasilar disease (a narrowing or blood clot in the arteries that supply blood to the brainstem)
- Brainstem arteriovenous malformation, AVM (a congenital defect involving abnormal veins and arteries that are tangled and are lacking the capillaries between them – the result is higher blood pressure in those veins which could result in the vein rupturing and bleeding in the brain)
Recognizing the symptoms is the first step in managing basilar migraines as well as your life around it.
Basilar migraines actually occur in two parts, the aura, and the actual migraine. The aura symptoms can last just a few minutes or as long as an hour. Symptoms shared with other aura migraines include:
- vision changes
- Tingling in the body (especially the hands and feet)
- seeing static or zigzagging lights
- sensitivity to light or noise
- seeing lights not coming from an explainable source
- seeing spots or stars
When to Call the Doctor – Most migraines are not dangerous or life-threatening, even though the pain and symptoms may be debilitating. Sometimes the symptoms you experience may warrant a trip to the ER, or at least a conversation with your doctor. Make sure you bring your migraine journal with you which documents your attacks, symptoms, and what treatments you used.
Talk to your doctor if you experience any of these symptoms or issues:
- If you start having any new or unusual symptoms that you’ve not had before
- If the pattern of your migraine’s changes
- If your headache or migraine suddenly feels different
- If you have a chronic illness like kidney, heart, or liver disease
- If you are pregnant
- If you have an immune deficiency disorder
If you experience any of these symptoms, don’t wait till your next appointment; call your doctor immediately.
If you suddenly experience symptoms (that are not a part of your established, diagnosed migraine pattern) that include headache with:
- Difficulty speaking
- Mental confusion
- Stiffness in the neck
- Tunnel vision
- Double vision
- A chronic headache that worsens after exertion, coughing, sudden movements, or straining
- Headache that occurs after a head injury – especially if it worsens in intensity or symptoms
- Stroke from migraine is extremely rare, but it does occur so be aware of the signs of a stroke
- A “thunderclap” headache – severe and abrupt
- If you are over 50 and have new headache pain
You want to rule out other conditions that may be present or could be causing your migraine so getting a diagnosis is essential.
Causes of basilar migraines
Basilar migraines are thought to be caused by arteries in your brain and neck being squeezed. Constriction of the basilar artery, an artery that goes through your neck and brain stem to bring blood up to your brain, is thought to be involved in causing basilar migraines. It’s not clear whether this is actually the case, though.
As with other migraines with aura, basilar migraines can be caused by a number of external factors, too. The most common causes of basilar migraines include:
- Loud music or noise
- Stress, both physical and emotional
- Motion sickness
- Poor posture
- Bright or flashing lights around you
- Strong smells
- Sudden changes in weather or air pressure (such as when you go to high altitudes)
- Additives in food, including nitrates, MSG, etc.
- Certain medications, such as for birth control or blood pressure
- Certain foods and beverages, such as those containing caffeine or alcohol
Less common causes of basilar migraines include:
- Not getting enough sleep, or even getting too much sleep
- Being on your menstrual period if you’re a woman
- Being overweight or obese
- Overusing headache or migraine medication, which can give you “rebound” headaches
- Experiencing an epilepsy seizure
The exact cause of basilar migraines is still not fully understood. A nerve is also cited as a possible cause. In some very rare cases, scientists believe that basilar migraine is familial, meaning that there is a genetic component that can be passed from parent to child.
Trauma or injury to the cervical spine (the neck), such as whiplash, can cause migraines. However, in some cases, even injuries to the thoracic (mid-back) or lumbar (lower back) can also cause migraines. Head injuries, concussion, and traumatic brain injuries may trigger migraines as well. In many of these cases, the problem is structural with pressure on the nerves or inflammation in that area that triggers the headaches.
Diagnosing Basilar Migraine
An individual who experiences any of the symptoms of basilar migraine should see their doctor. Getting a diagnosis can help direct treatment, but it can also rule out any underlying causes of the condition.
The International Classification of Headache Disorders, 3rd edition, provides detailed diagnostic criteria for basilar migraine:
- At least two attacks fulfilling criteria BD
- Aura consisting of visual, sensory and/or speech/ language symptoms, each fully reversible, but no motor or retinal symptoms
- At least two of the following brainstem symptoms:
- decreased level of consciousness
- At least two of the following four characteristics:
- at least one aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession
- each individual aura symptom lasts 5-60 minutes
- at least one aura symptom is unilateral
- the aura is accompanied, or followed within 60 minutes, by headache E. Not better accounted for by another ICHD-3 diagnosis, and the transient ischemic attack has been excluded.
It is recommended that a headache specialist or neurologist make the diagnosis.
Part of the reason for this is they are qualified to identify any neurological problems or conditions that could be causing the migraines. They will also have to rule out other conditions that are more serious, including:
- Meniere’s disease
- Vertebrobasilar disease
- Brainstem arteriovenous malformation
- Brain lesions
- Vestibular disorder
Basilar migraine is often mistaken for hemiplegic migraine. The symptoms of these two conditions are very similar. The primary difference is the motor weakness that is present during a hemiplegic migraine.
When forming a diagnosis, the doctor will talk to the patient about their headaches as well as any family illnesses or conditions. Diagnostic tools they may use include CT scan, MRI, and lumbar puncture. These will help rule out other conditions or issues that may contribute to the migraines.
Treating a basilar migraine
There is no magic bullet for treating basilar migraines and for some pain management is extremely difficult, if not impossible. In most cases, treatment includes a combination of medication, lifestyle changes, dietary changes, and even surgery. Many migraine patients have found relief with chiropractic care, yoga, and acupuncture.
Migraines don’t always have a traceable cause, so treating the underlying causes of a migraine can be difficult. Treating the symptoms of basilar migraines is the most effective way of relieving the pain and discomfort that goes along with having a migraine.
Some common medications to reduce basilar migraine symptoms (as well as those of other migraines with aura) include:
- Nonsteroidal anti-inflammatory drugs (nsaids) for relieving headache pain, such as ibuprofen (Advil)
- Antinausea medications, such as metoclopramide (Reglan)
- Nsaids (ibuprofen)
For the most part, the treatment focuses more on the management of symptoms than it does stopping the migraine.
Management of Environmental or Lifestyle Triggers
Learning to manage lifestyle or environmental migraine triggers can be a big step for many migraineurs. By giving them some control over a seemingly out of control situation, they can make empowering, proactive steps in their own health management.
It is important to keep a headache journal so you can track your symptoms and patterns of your migraines. You can then use the information to identify migraine triggers. Once you have an idea of what is causing your migraines, you can take steps to manage that within your own environment. For instance, if bright lights trigger your headache, you can choose window coverings that either (depending on your degree of sensitivity) block the light or filter it so it is softer.
Diet, regular exercise, good quality sleep, and stress management are all vital to not only decreasing the incidence or severity of your migraines but for your overall health as well. A consistent schedule that you can establish for most days can help as well. Skipping meals is a well-known migraine trigger, so setting regular mealtimes is essential.
Some women find that estrogen is a migraine trigger. If that is the case for you, or if you believe it worsens your headaches, talk to your doctor about reducing or avoiding medications that contain the hormone. This can include hormone replacement therapy and birth control pills.
Learning to cope (LTC) is not necessarily a new migraine management strategy, but recent research indicates it can be very effective in migraine prevention. The process involves gradual exposure to migraine triggers in an effort to desensitize the body and brain against them. Cognitive-behavioral therapy may also be used along with LTC.
Many migraineurs are looking for more natural ways to prevent and manage their migraines. There are quite a few options, but it is important to remember that what works for one person may not work for another. As with any migraine treatment, you have to find what works for you. Everyone is different and so are their migraines.Lavender and peppermint essential oils: Many people are turning to aromatherapy and using essential oils for migraines with great success.
Lavender oil is very soothing, calming the mood and acting as a sedative to relieve stress and anxiety. Inhaling lavender can begin decreasing your headache in as little as 15 minutes.
Peppermint oil has a stimulating aroma that helps you breathe easier. When applied to the skin, it increases blood flow and can calm the contractions of the muscles.
When using essential oil as a topical application, you may want to use a carrier oil like jojoba or almond oil to soften the aroma and decrease your skin’s sensitivity. Using coconut oil as a carrier oil provides additional health benefits such as balancing your hormones. You should always test essential oils on your skin (the wrist area is a good test spot) before using to make sure you aren’t sensitive to it. When using it to relieve migraines apply it to your forehead, temples, and back of the neck.
- Chiropractic: Spinal manipulation has long been touted as an effective treatment for migraines and several studies support those assertions. In the case of basilar migraines, chiropractic care may be particularly effective since the condition seems to be rooted in inflamed nerves and neural pathways.
- Butterbur and Feverfew: Butterbur is an herb that acts as a beta-blocker and has anti-inflammatory properties making it good for reducing the effects of migraine triggers. The recommended dose for migraine treatment and prevention is 75 mg twice a day.
Studies show that Feverfew is not only effective in reducing migraine frequency, it also helps with the associated symptoms which include nausea, light sensitivity, noise sensitivity, vomiting, and pain. It can be taken as a capsule, tablet, or liquid extract. The recommended dose for migraine treatment is 50 to 100 milligrams.
- Magnesium: Several studies show that magnesium is often quite effective in reducing migraine frequency, especially in people who have low magnesium levels. People who may have low levels of magnesium include those who diuretics (for blood pressure or other reasons) and people with heart disease or diabetes. Alcoholism has also been associated with low magnesium levels. The recommended dose of magnesium is between 200 and 600 mg a day.
Compiled using information from the following sources: