basilar artery migraine

Last edited 11/2020 and last reviewed 01/2023

Basilar artery migraine is a variety of classical migraine seen most commonly in young women and has an aura that was believed to be due to vertebro-basilar ischaemia:

• originally the terms basilar artery migraine or basilar migraine were used but, since involvement of the basilar artery is unlikely, the term migraine with brainstem aura is preferred
• there are typical aura symptoms in addition to the brainstem symptoms during most attacks
• many patients who have attacks with brainstem aura also report other attacks with typical aura

The proceeding headache is often occipital.

Definition:

• originating from the brainstem, but no motor weakness

Diagnostic criteria:

A. Attacks fulfilling criteria for " Migraine with aura" and criterion B below

B. Aura with both of the following:

• 1. at least two of the following fully reversible brainstem symptoms:
• a. dysarthria1
• b. vertigo2
• c. tinnitus
• d. hypacusis3
• e. diplopia4
• f. ataxia not attributable to sensory deficit
• g. decreased level of consciousness (GCS <=13)5
• 2. no motor6 or retinal symptoms

Notes:

• 1. Dysarthria should be distinguished from aphasia
• 2. Vertigo does not embrace and should be distinguished from dizziness
• 3. This criterion is not fulfilled by sensations of ear fullness
• 4. Diplopia does not embrace (or exclude) blurred vision
• 5. The Glasgow Coma Scale (GCS) score may have been assessed during admission; alternatively, deficits clearly described by the patient allow GCS estimation.
• 6. When motor symptoms are present, then is classified as Hemiplegic migraine.

Note that many of the symptoms listed under criterion B1 may occur with anxiety and hyperventilation, and are therefore subject to misinterpretation (2)

Reference:

• Ashina M. Migraine. N Engl J Med 2020;383:1866-76. DOI: 10.1056/NEJMra1915327
• Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia 2018; 38: 1-211