Basilar Migraine (BM): Definition: A rare subtype of migraine with aura, characterized by symptoms originating from the brainstem and/or both hemispheres of the brain.
– Diagnosis:
Criteria (IHS): At least two attacks with fully reversible symptoms (e.g., dysarthria, vertigo, tinnitus, diplopia, ataxia, decreased level of consciousness) lasting 5–60 minutes, followed by headache. –
Exclusion: Other causes (e.g., stroke, epilepsy) must be ruled out via imaging (MRI, MRA) and EEG. – Prevalence: Estimated at 1–2% of migraine patients, more common in adolescents and young adults. –
Treatment:
Acute: Triptans (e.g., sumatriptan), antiemetics (e.g., metoclopramide), or NSAIDs (e.g., ibuprofen). – Prophylaxis: Beta-blockers (e.g., propranolol), tricyclic antidepressants (e.g., amitriptyline), or topiramate. –
Complications:
Rare: Migraine stroke (if aura lasts >60 minutes), persistent neurological deficits, or status migrainosus (prolonged attack). – Rationale: BM’s brainstem involvement increases stroke risk; prompt treatment reduces complications. Note: Always consult a neurologist for confirmation and tailored management.