Basilar migraines are also known as Bickerstaff syndrome, brain stem migraine and vertebrobasilar migraine. The term basilar type migraine is actually a bit misleading since it implies that the attack is vascular in origin. It was first termed basilar because it was believed to be a results of the spasm of the basilar artery but since then it has been shown that it is a genetic neurological disorder as are other types of migraines. There is a vascular components at the origin is believed to be in neurological.
Early literature about the subject of basilar migraines found that it was most common in adolescent females but continued research and statistical analysis has shown that it affects all age groups and both male and female. There does seem to be some female predominance seen an overall migraines, but basilar migraines affect the same number of males and females.
This type of migraine is known for their strange aura symptoms. Individuals may experience a visual aura that can be on both sides and potentially so bad that it leads to temporary blindness. It is often followed by uncoordination, double vision and vertigo as well as jerky eye movements, trouble hearing and slurred speech. This stage of the basilar migraine attack can last between five minutes and 60 minutes, but in some cases has lasted as long as a day. Even worse is that these symptoms often come in succession, one right after the other, and not all at once.
The unique feature of basilar migraines is that it seems to happen in either the brainstem or both cerebral hemispheres. This will change the way the attack happens, the way it is seen functionally and the way in which it is treated. The symptoms are often concerning because they mimic those of other more serious conditions so if you have symptoms which are new you should see your physician immediately.
When you go to see the doctor with symptoms of a basilar migraine don’t be surprised if you are put through a full workup to rule out a stroke. Because basilar migraines will mimic a stroke, as well as puts you at a higher risk for developing a stroke, the doctor will probably include an MRI or CT scan of the brain right away. He may also include an imaging tests to look at the arteries of the brain looking for a potential aneurysm. A full examination as well as history will also be performed. The doctor may include an EEG test to rule out a seizure since vertigo and headaches are common symptoms of seizure activity.
Cheese and wine are considered common food triggers as well as other food additives such as nitrates and monosodium glutamate found in processed meats and foods. Consuming alcohol can also worsen basilar migraines so it must be limited or avoided altogether. Individuals who can maintain a food diary and note the foods which they consume each day as well as the days in which they get basilar migraines will find it helpful way in order to decrease the number of migraines or prevent them altogether.
A basilar migraine is a rare form of migraine headaches. Because of the decreased frequency in the overall population it has not received a great deal of study and currently there are no special types of medications developed for specifically for this type of migraine. Generally, individuals who are suffering from a basilar migraine prefer absolute dark in an isolated room which helps give them some relief from the severe pain.
Once the physician has ruled out a stroke or other serious medical conditions, the treatment is usually pretty straightforward. The goal of treatment is to decrease the pain of a headache. If the headache is disabling and happens more than a couple times a month then daily therapy for a few months to a year to prevent the onset may be in order. There are several different preventative medications for migraines but the drug of choice for a basilar migraine is Verapamil taken once or twice a day. If you are not able to use verapamil because of other medical conditions then beta-blockers such as Inderal are another good choice.
When an attack does occur small doses of painkilling medication may help to decrease the pain and keep it under control. The goal of treatment is to continue to allow the individual to function normally on a daily basis.
While this type of migraine continues to be rare and the number of studies aimed at directly determining age specific treatment protocol continues to be small the amount of research done each year into migraines continues to show hope to sufferers.
International Headache Classification: Basilar Type
European Journal of Emergency Medicine: Basilar Migraine
Office of Rare Disease Research: Basilar Migraine
American Headache Society: Basilar Type Migraine
National Headache Foundation: Basilar Migraine
University of Maryland medical Center: Migraine Headaches