A migraine with predominant brainstem aura symptoms is known as a basilar migraine. Other names for it are basilar artery migraine, basilar-type migraine, migraine with brainstem aura, vertebrobasilar migraine, and Bickerstaff migraine. Spasm of the basilar artery was the suspected cause of basilar migraine but there isn't enough evidence to support this theory.
The cause of basilar migraine is still unknown, but it's connected to the tightening of the blood vessels. Vasoconstriction happens because the muscles around arteries become too tight and block blood flow.
Migraines With Aura
Basilar migraines are considered a migraine with aura. This type of migraine have symptoms that affect your senses, especially your sight. You might see spots or lines in your vision or experience double vision and abnormal flashes of lights. During these disturbances or soon after, you get a bad headache.
About one-fourth of all 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 coming from the brainstem or both cerebral hemispheres at the same time. This means your symptoms may appear on one or both sides of your body.
Basilar migraines usually last for only an hour or so. A more severe episode of basilar migraine may last for a few hours, but this usually isn't a result of any serious condition. With proper treatment, they can be managed without interrupting your daily life.
This type of migraine may last anywhere from 4 to 72 hours and it takes even more time to recover from a migraine attack. 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 (hyperacusis)
- 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 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. A migraine with aura, just as variant migraine, doesn't have to manifest only in head pain. Other symptoms of basilar migraine are:
- 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
Migraine with brainstem aura, neurological migraine, and migraine without aura are often not 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:
- Start having any new or unusual symptoms that you’ve not had before
- Notice the changes in migraine attacks
- Feel headache or migraine differently
- Have a chronic illness like kidney, heart, or liver disease
- Are pregnant
- Have an immune deficiency disorder
Don’t wait too long to get medical advice. You need to call your doctor, schedule your next appointment, and get a diagnosis or treatment. Getting a diagnosis is essential for ruling out other possible conditions that may be causing your migraines.
You should also call a doctor if you have migraine symptoms that you haven't experienced before such as:
- 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
Causes of basilar migraines
Basilar migraine is probably caused by arteries in your brain and neck being squeezed. Constriction of the basilar artery, the one going through your neck and brainstem 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 several external factors, too. The most common causes of basilar migraine are:
- 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 migraine 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 migraine is still not fully understood. A nerve is also cited as a possible cause of basilar type migraine. Some scientists also believe that basilar migraine is hereditary.
Trauma or injury to the cervical spine (the neck), such as whiplash, might cause migraines. Even injuries to the thoracic (mid-back) or lumbar (lower back) can cause migraines. Head injuries, concussion, and traumatic brain injuries may trigger migraines too. As you can see, the problem is structural. If you put pressure on the nerves, you risk inflammation that triggers basilar migraines.
Diagnosing Basilar Migraine
An individual who experiences symptoms of basilar migraine should see their doctor. Getting a diagnosis will help you treat basilar type migraines. A clinical diagnosis of migraine with brainstem aura will also rule out any underlying causes of the condition.
The International Classification of Headache Disorders, 3rd edition, provides detailed diagnostic criteria for migraine with brainstem aura (known as basilar migraine):
- Two attacks fulfilling criteria BD
- Aura consisting of visual, sensory, or voice-related symptoms, each fully reversible, but no motor or retinal symptoms
- Brainstem aura symptoms such as hyperacusis, vertigo, ataxia, dysarthria, tinnitus, diplopia, etc.
- At least two of the following four characteristics:
- brainstem aura symptom spreads gradually over 5 minutes, and/or two or more symptoms occur in succession
- each aura symptom lasts 5-60 minutes
- at least one aura symptom is unilateral
- the brainstem 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 of the migraine with brainstem aura. These doctors are qualified to identify any neurological problem that could be causing a migraine with brainstem aura. They will also have to rule out other more serious conditions, 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 main difference is that during a migraine with brainstem aura patients don't experience motor weakness.
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 basilar migraine.
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 improvements, and even surgery. Many basilar migraine patients have found relief with chiropractic care, yoga, and acupuncture.
Migraine with brainstem aura doesn't have a treatable cause, so getting a relief might 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 with aura.
Medications for Basilar Migraine
Some common medications to ease the symptoms of basilar migraine (and 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 of migraine with brainstem aura 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 taking control of the situation, they can make empowering, proactive steps in the management of migraine with brainstem aura.
It is important to keep a headache journal to track patterns and symptoms of migraine attacks. Journaling will help you identify migraine triggers. Once you figure out what causes your migraines, you can make changes in your environment to manage the basilar migraine. For instance, if bright lights trigger your headache, you can choose window coverings that either block or filter light.
A healthy diet, regular exercise, good quality sleep, and stress management are crucial for relieving migraine symptoms. Even small changes count. For example, try to make a meal schedule you will follow because skipping meals is a common migraine trigger.
Some women find that estrogen is a migraine trigger. If you think that your type of migraine is triggered by high doses of estrogen, talk to your doctor about reducing or avoiding medications that contain the hormone.
Learning to cope (LTC) is another possible migraine management strategy. 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 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. Everyone is different and so are their migraines. As with any migraine treatment, try something that's feeling right for you personally.
Migraine with typical manifestation can be prevented and relieved with the following:
- 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. It may help to relieve stress and anxiety. Inhaling lavender can relieve some types of headaches in just 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. You should always test essential oils on your skin (the wrist area is a good test spot) before using to make sure you won't have a strong reaction. 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. The recommended dose of magnesium is between 200 and 600 mg a day.
Although basilar migraines are tricky, you can fight them with different methods. Medications or lifestyle changes are just one way to combat your migraine. One natural product you could use to stop your migraines is the Migraine Stopper. This device helped a lot of people, so maybe it could help you too.