Basilar Artery Migraine

Basilar artery migraine (also known as Bickstaff's Migraine or Basilar-type migraine) is an uncommon type of migraine due to its unusual aura. Auras are symptoms that precede the actual headache for many migraine patients. In the case of basilar artery migraine, the aura stems from interference in the deepest portions of the brain (the brainstem). Aura symptoms in this special type of headache include the following:

Temporary blindness

Ataxia (poor coordination and ability to walk)

Vertigo (a sense of spinning or movement in the head)

Lightheadedness (feeling like your blood pressure is low)

Tinnitus (hearing tones or whooshing noises)

Diplopia (double-vision)

Nystagmus (rapid, back and forth, movements of the eyes)

Dyarthria (slurred speech)

Bilateral paresthesias (tingling sensations on both sides of the body)

Weakness (sometimes alternating to both sides of the body)

Change in level of consciousness (sleepy, stuporous, or even becoming unconscious)

Poor cognition (inability to think well, accurately)

Of course not all patients will experience all of these symptoms - some may experience only a few of the aura symptoms above.

The head pain itself, starting either after some of the symptoms listed above or at the same time, is usually located at the back of the head and can have associated nausea and vomiting, as well as sensitivity to light, sound, or smell. It may also be worsened with mild activity.

The main concern in the case of these headaches is that a transient ischemic attack, a stroke or a seizure is not the cause. Thus patients with these symptoms (the first time they are experienced) are usually advised to proceed to the hospital for initial evaluation

Because the basilar artery is the main blood supply to the brainstem, this artery has become associated with the name of the migraine. The artery, though, is not felt to be abnormal in this type of headache.

If a patient experiences weakness as part of the aura, then Hemiplegic Migraine must be considered a possibility.

Initially felt to affect only female children, it is now recognized that any age and gender can be affected by basilar artery migraine.

Treatment

Any of the usual acute treatments for migraine may also be used in the case of this special type of migraine. There is controversy regarding the use of triptan medications (Imitrex, Maxalt, Zomig, Relpax, etc.), as there is concern that these could cause strokes in patients with this type of headache. While this has not in fact been proven to be the case, most neurologists avoid this class of medications for this reason. This same relative contraindication would apply to other vasoactive (artery constricting) drugs such as a class of medication called ergotamines.

Verapamil, a calcium channel blocker, is the preventative medication of choice for basilar artery migraine. If this is not effective in reducing the frequency and intensity of headaches, then other standard preventative medications can be used. Beta-blocking medications (Inderal, propranolol, Corgard) are often avoided, as they may cause prolongation of auras and there has been concern that they could make migrainous infarction (a stroke associated with a migraine) more likely to occur.

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