A basilar migraine, also known as basilar-type migraine (BTM), is a subtype of migraine with aura symptoms originating from the brainstem or the simultaneous involvement of both hemispheres. This type of migraine is also referred to as basilar artery migraine, Bickerstaff syndrome, vertebrobasilar migraine and brainstem migraine.
Basilar Migraine Symptoms
How do you know you or a loved one has this particular type of migraine? It’s important to recognize the most common basilar migraine symptoms. According to the American Headache Society, the symptoms experienced by BTM sufferers, in order from most to least common, are as follows:
- Visual aura: 100% of BTM patients describe having this symptom. 40% say they experience symptoms in both fields of vision while 60% only experience aura on one side or the other. Aura most commonly consists of a spinning sensation (vertigo), noise in the ears (tinnitus), double vision (diplopia), hearing problems (hypacusia), poor limb coordination (ataxia), and unpleasant sensations in the face arms or legs (ranging from prickling to stinging to burning). Temporary blindness can also occur, which is one reason BTM can be so scary.
- Headache: 98% of sufferers say they experience migraine-level headaches without aura, during aura, or within 60 minutes of aura symptoms occurring.
- Aphasic aura: This is when the ability to speak, read or write properly is affected. 40% of basilar migraine patients report this symptom.
Migraine sufferers should understand that each aura is different, and each aphasic experience may be different from the next as well. These symptoms can be frightening, but understanding them and realizing you’re not alone can be a great comfort.
According to Medscape, single-photon emission computed tomography (SPECT) studies have uncovered that regional cerebral blood flow in the posterior circulation is reduced during the aura phase of a migraine attack. Even though Doppler ultrasonography doesn’t pick up on any changes in blood flow velocity, this finding with SPECT scans is certainly worth noting.
After all, according to a publication in the Oxford Journals, reductions in cerebral blood flow could be what cause aura symptoms. Limited blood flow in the brain could also be part of the underlying connection between migraines and brain infarcts (when loss of blood supply causes brain tissue to die).
Online Mendelian Inheritance in Man (OMIM) reveals that a novel mutation occurs in the ATP1A2 gene among family members who suffer from BTM. In a case study from 2005, a father and his son both experienced this type of migraine and both had a heterozygous mutation in the ATP1A2 gene. The migraines started at age 12 for the father and age 15 for the son. Both experienced aura leading up the migraine along with other typical migraine symptoms (headache, vomiting, nausea and yawning) set in soon after the resolution of the aura. The ATP1A2 mutation was also found in father’s cousin and paternal uncle, both of whom also suffered from BTM.
Non-Drug Migraine Treatments
The University of Maryland Medical Center (UMM) reports that you can treat migraines in several ways that don’t include drugs. These include:
- Biofeedback therapy to teach the patient how to monitor and respond to physical responses of an impending migraine attack
- Relaxation therapy to provide pain relief during a basilar migraine
- Cognitive behavioral therapy to help patients cope with stress and change the way their body reacts to anticipated migraine pain
Modern Migraine Drugs
Once, triptans and ergotamines were not recommended for BTM patients. However, the American Headache Society reveals that in 2001, three headache specialists reported on 13 patients with various migraine types, including BTM. When given triptans, the patients suffered no adverse effects; in fact they experienced much-needed relief from their headache and other symptoms. Later the specialists did more studies on a larger group meeting the criteria for BTM and saw only positive results from administering triptans. The specialists concluded that prescribing triptans for BTM patients on a wide scale could render real positive results.
UMM reminds migraine sufferers that the painful headache portion of a migraine can be treated with over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen. These are most effective if you take the drugs early on when the pain is still mild.
In 2012, the American Academy of Neurology (AAN) updated its guidelines for preventing migraines in adults. Preventative treatments recommended by the AAN include one or more of the following medications:
- Anti-seizure drugs (topiramate, divalproex or valproate)
- Beta-blockers (propranolol, timolol or metoprolol)
- Antidepressants (amitriptyline or venlafaxine)
Discuss your treatment options with your doctor. Depending on your specific symptoms, family history and willingness to try non-drug treatments, your doctor can help you make the best decision for preventing and treating basilar migraine.
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