Basilar migraine is an uncommon type of migraine It is associated with mainly brainstem-related symptoms. It is seen in young women or kids with a family history of migraines. It affects both males or women almost equally.
Initial presentation is visual disturbances involving both eyes visual fields.
It may be associated with dysarthria, vertigo, tinnitus, hearing impairment, double vision (diplopia) , gait disturbances (ataxia) , decreased level of consciousness, bilateral paresthesia, with no motor or retinal symptoms, and completely reversible symptoms
The above symptoms last 10 to 30 min. They are followed by headaches. Headache is commonly localized to the occipital region.
But in few patients may experiences changes in consciousness ranging from simple fainting, confusion, or stuporous state which may persist as long as several hours or days. Very rarely patient may have a coma or weakness of all four limbs.
The symptomatology of basilar migraine resembles those of basilar artery distribution ischemia.
- The exact etiology of basilar migraine is not known. environmental factors play a role.
- The genetic role is suggested, but it lacks scientific evidence.
- Common triggers (like in other types of migraine) include strong smells, loud noises, weather changes, excessive sleep, lack of sleep, increased stress, intense physical exertion, oral contraceptives, foods like cheese, alcohol, caffeine, and certain food preservatives like monosodium glutamate.
Imaging of the brain like CT or MRI brain, angiography is advised to rule out acute pathologies in brain-like Brain stroke, AV malformations, and tumors. In case of unconsciousness or confusion, EEG is advised to rule out seizures .
Treatment of acute attack is symptomatic and usually managed with NSAIDS and antiemetic medications.
Verapamil and topiramate are the most commonly used medications for preventing migraine with brainstem aura.
For preventing attacks It is important to identify and modify the triggers if possible.
Modification of triggers like food, noise, stress, regular exercise, a well-balanced diet, and stress management can help prevent migraine attacks.
Relaxation, acupuncture, massage, cognitive behavior therapy, and biofeedback techniques.