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.
