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Migraine with brainstem aura occurs in 1 in 10 people who get migraine with typical visual aura
Brainstem migraine is a type of migraine with aura that begins in the brainstem with intense throbbing or pulsating pain on one or both sides of the back of the head (occipital area).
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
- Hunger
- Motion sickness
- Alcohol
- Caffeine
- Dietary nitrites
- Being overweight or obese
- Bright or flashing lights
- Seizures
- 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
- Confusion
- Slurred speech (dysarthria)
- Nausea
- 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:
- Seeing flashing lights
- Seeing spots or lines
- Weakness or exhaustion
- Numbness in the head, hands, or face
- Temporary vision loss
- Increased sensitivity to sound (hyperacusis)
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:
- Slurred speech
- Double vision
- Temporary loss of hearing
- Ringing in the ears
- Loss of muscle control
- Numbness on both sides of the body (bilateral paresthesia)
- Vertigo
- Decreased level of consciousness
- 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
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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:
- Stroke
- Epilepsy
- Meningitis
- Vestibular disorders
- Meniere’s disease
- Brainstem arteriovenous malformation
- Brain tumor
How do you stop brainstem migraines?
- Medications
- 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