basilar migraine
Pathophysiology:
Basilar migraine, also known as basilar-type migraine or migrainous brainstem aura, is thought to involve dysfunction in the brainstem and its connections. It may be related to cortical spreading depression (a wave of neuronal depolarization) affecting the occipital cortex and brainstem structures.
Symptoms:
- Severe headache with at least two of the following symptoms: dizziness, double vision, difficulty speaking, tingling or numbness, and hearing unusual noises.
- Aura symptoms may include visual disturbances like flashing lights or zigzag lines, which can last 10–60 minutes before the headache begins.
Treatment:
- Acute treatment: Triptans (e.g., sumatriptan), ketorolac, dihydroergotamine, lasmiditan, ubrogepant. Non-pharmacological options like rest in a dark room may also help.
- Preventive treatment: Beta-blockers (propranolol), anticonvulsants (topiramate, valproate), and tricyclic antidepressants (amitriptyline) are commonly used.
Complications:
Rarely, basilar migraines can lead to prolonged or severe neurological symptoms. If aura lasts longer than an hour without headache, seek medical attention for possible stroke evaluation.
Rates/Epidemiology:
Basilar migraine is rare, affecting about 10% of people with migraines. It typically starts in adolescence and may decrease after age 35.
Differential Diagnosis (Diff DX):
- Stroke or TIA: Imaging studies like MRI/MRA are crucial to rule out vascular causes.
- Epilepsy: Aura symptoms can mimic seizures, but basilar migraine lacks the stereotypical seizure activity on EEG.
- Multiple Sclerosis: Brainstem lesions may cause similar symptoms; imaging helps differentiate.
