Migraine with brainstem aura
A rare type of migraine with aura
What is migraine with brainstem aura?
Formerly known as basilar-type migraine.
It occurs with neurological symptoms that would include at least two of the following:
- slurring of speech (dysarthria)
- a sensation of movement (vertigo)
- ringing in the ears (tinnitus)
- double vision (diplopia)
- Unsteadiness when walking as if drunk (ataxia)
- Temporary decreased consciousness (syncope)
- Pins and needles and /or numbness affecting both arms and/or legs
- Changes in eyesight in both eyes such as patterns or flashing lights
Migraine with brainstem aura symptoms often develop gradually and occur with or before a typical migraine headache in those who experience it.
Migraine with brainstem aura occurs in about 1 in 10 people who get migraine with typical visual aura. Vertigo, dizziness, slurred speech, ringing in the ears and double vision would also commonly occur.
Some people experience disorientation or confusion as well as temporary loss of consciousness, known as syncope.
In general, most people with migraine with brainstem aura first experience symptoms in adult life although it can occur at any age. However, if a first migraine attack develops after 50, it will need further investigation such as an MRI scan, to rule out some other causes.
What causes migraine with brainstem aura?
Cortical spreading depression (CSD) is believed to be the brain mechanism that generates migraine with brainstem aura, similar to typical visual aura in migraine. However, the current understanding is that CSD occurs either in the brainstem (the base of the brain) or additionally on the surface of the brain (cerebral cortex).
Like other forms of migraine with aura these attacks can be triggered by certain things.
Diagnosing migraine with brainstem aura
Migraine with brainstem aura should be distinguished from hemiplegic migraine. Hemiplegic migraine causes temporary weakness on one side of the body, usually in the face and arms but may also affect the legs.
People experiencing migraine with brainstem aura attacks may be considered and investigated for some other conditions such as Meniere’s disease, ischaemic stroke, epilepsy or vestibular disorders affecting the ear causing vertigo. Other conditions will need to be ruled out to receive the appropriate diagnosis and treatment.
Migraine with aura has a slightly higher risk of stroke than migraine without aura; however, there is no evidence that migraine with brainstem aura has a higher risk of stroke than migraine with typical aura.