What are the other Names for this Condition? (Also known as/Synonyms)

• Basilar Artery Migraine
• Bickerstaff Migraine
• Vertebrobasilar Migraine

What is Migraine with Brainstem Aura? (Definition/Background Information)

• Migraine headache is a chronic neurological disorder and the most common form of headache that is characterized by severe pounding and pain on one side of the head, which can last for several hours
• Migraine with Brainstem Aura (MBA) is a unique type of migraine headache that originates in the brainstem, which is the posterior part of the brain, nearer to the base of the head and cervical (neck) spinal cord region. MBA was earlier known variously as Basilar Artery Migraine and Basilar-type Migraine
• An ‘aura’ is a transient phenomenon that consists of a set of sensory or neurological disturbances that manifest commonly as bright dots, flashes and sparks, including numbness and tingling sensation, one-sided weakness, and dizziness
• In Migraine with Brainstem Aura, the pain is felt on one side or back of the head, which then involves the entire head growing in intensity, and is usually followed by nausea. The aura is observed anywhere between 5 to 45 minutes before onset of the migrainous pain
• Individuals of any age group are prone to Migraine with Brainstem Aura, while some unproven reports indicate that young adolescent girls have a higher risk for this condition. It is believed that rarely, MBA may be inherited in an autosomal dominant manner
• The exact cause of Migraine with Brainstem Aura is not known, but certain common trigger factors have been established that may include food, stress, and lack of sleep. The involvement of certain gene mutations (on ATP1A2 gene or CACNA1A gene) are being currently researched into
• There are multiple medications, non-traditional techniques, and home remedies available for the treatment of Migraine with Brainstem Aura. The prognosis of the disorder is generally good with appropriate treatment in most individuals

Who gets Migraine with Brainstem Aura? (Age and Sex Distribution)

• Migraine with Brainstem Aura is a rare and unusual condition that is observed in individuals of any age category
• Both males and females may be affected, although a higher prevalence is observed among females
• Worldwide, individuals of all racial and ethnic groups may be affected

What are the Risk Factors for Migraine with Brainstem Aura? (Predisposing Factors)

• Currently, no risk factors have been clearly identified for Migraine with Brainstem Aura
• A positive family history may be an important risk factor, since it is researched that MBA may be occasionally inherited

The common risk factors for migraine headaches include:

• Boys and girls in their teens are more at risk for migraines
• Hormonal changes: Women are likely to be affected by migraine headaches either before or after the onset of menstruation, pregnancy, and menopause, due to hormonal changes that occur in the body

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Migraine with Brainstem Aura? (Etiology)

The exact cause of Migraine with Brainstem Aura (MBA) is not well understood. The aura experienced is believed to be related to some abnormality with electrical signals being processed by the brain.

• Even though not clearly established, the involvement of ATP1A2 gene or CACNA1A gene mutation is reported
• Rarely, MBA is observed to run in families and the condition is believed to be inherited in an autosomal dominant manner

Autosomal dominant mode of inheritance: Autosomal dominant conditions are traits or disorders that are present when only one copy of the mutation is inherited on a non-sex chromosome. In these types of conditions, the individual has one normal copy and one mutant copy of the gene. The abnormal gene dominates, masking the effects of the correctly function gene. If an individual has an autosomal dominant condition, the chance of passing the abnormal gene on to their offspring is 50%. Children, who do not inherit the abnormal gene, will not develop the condition or pass it on to their offspring.

In general, some of the likely causes for migraines include:

• Dilatation of blood vessels in the brain
• Release of certain chemicals
• Presence of an excess amount of dopamine and serotonin; an unusual sensitivity of the blood vessels to dopamine and serotonin is noted

The following factors are known to trigger migraine headache attacks:

• Certain foods such as chocolate, cheese, nuts, alcohol, and monosodium glutamate (MSG, a food enhancer)
• Missing out on meals
• Physical and mental stress; physical exertion
• Use of birth-control pills
• Smoking and alcohol
• Hormonal changes in women during their menstrual cycle
• Lack of sleep
• High altitudes
• Certain medications
• Beverages containing caffeine

What are the Signs and Symptoms of Migraine with Brainstem Aura?

The signs and symptoms of a Migraine with Brainstem Aura differ from one individual to another. These include:

• Pain on one or both sides of the head; throbbing/pulsating pain that grows in severity
• Pain at the back or base of the head
• Headache pain that may last from 4 hours to 72 hours
• Nausea
• Changes in mood
• Fatigue
• Individuals may observe increased sensitivity to sound and light
• Eating difficulties
• Difficulty in concentration
• Stomach upset
• Lethargy

The ‘brainstem aura’ may be observed as any or all of the following symptoms (about 5 minutes to less than an hour before migraine headache):

• Visual symptoms such as seeing various shapes, bright spots, flashes of light, or zig-zag patterns
• Vision loss or partial vision; double vision
• Pins and needles sensation in the arms or legs
• Speech defects
• Hallucination
• Ringing in the ears; poor hearing
• Unsteadiness and vertigo
• Anxiety and hyperventilation
• Some individuals may find the ‘aura’ experience alarming and tend to believe that it forewarns a brain stroke or some other neurological condition

It is important to note that individuals who experience ‘aura’ during an attack of migraine may not experience the aura during a subsequent attack. It is difficult to predict in whom and when will such an experience occur.

How is Migraine with Brainstem Aura Diagnosed?

The diagnosis of Migraine with Brainstem Aura may include:

• Complete physical examination and assessment of signs and symptoms
• Thorough analysis of personal and family medical history
• Neurological examination by a qualified healthcare provider, if necessary
• Laboratory tests may be performed to rule out other causes for pain
• Computerized tomography (CT) scan of the head
• Magnetic resonance imaging (MRI) scan of the brain

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Migraine with Brainstem Aura?

The complications of Migraine with Brainstem Aura may include:

• Loss of balance and unconsciousness
• Temporary paralysis of one part of the body
• Some headaches may be severe and last over 3 days
• In some, the condition may be frequent and debilitating
• Emotional and mental stress
• Poor performance at school or at work
• Recurrence of the condition
• Headaches due to medication overuse
• Low risk for brain stroke against a background of migraine attack

Complications may occur with or without treatment, and in some cases, due to treatment also.

How is Migraine with Brainstem Aura Treated?

Generally, Migraine with Brainstem Aura is treated using the following medications and measures:

• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Antiemetic medication such as chlorpromazine and metoclopramide
• Other pain medication for mild to moderate cases, such as acetaminophen, aspirin, triptans, etc.
• Preventive medications may include blood pressure medication, antidepressants, anti-seizure drugs, and calcitonin gene-related peptide (CGRP) inhibitors
• Nerve block procedures

Some of the non-traditional therapies that are used in treating migraine headaches include:

• Acupuncture
• Biofeedback (relaxation technique)
• Manual therapy involving massage and chiropractic treatments
• Use of vitamin and mineral supplements

Certain home care treatments may include:

• Muscle relaxation exercises including meditation, yoga, listening to music, and gardening
• Getting adequate sleep; while sleeping, resting in a dark quiet room
• Applying ice packs

How can Migraine with Brainstem Aura be Prevented?

The prevention of Migraine with Brainstem Aura involves bringing about some lifestyle changes that may include:

• Avoidance of triggers
• Reducing the effects of estrogen (for women)
• Having a stress-free routine with regular sleeping habits
• Regular exercise

In some cases, the condition is not preventable; although, the frequencies of the migrainous episodes may be reduced. Regular medical screening at periodic intervals with tests and physical examinations are recommended.

What is the Prognosis of Migraine with Brainstem Aura? (Outcomes/Resolutions)

• The prognosis of Migraine with Brainstem Aura (MBA) is dependent upon the severity of the signs and symptoms and associated complications, if any. Since, these conditions are very rare, information available on their overall prognosis is quite limited
• Individuals with mild conditions have better prognosis than those with severe symptoms and complications; in some, the condition can be disabling. Typically, the prognosis may be assessed on a case-by-case basis
• However, reports indicate that the frequency of the MBA episodes may decrease with age. Some reports also inform that MBA may transform over years and decades, to other more common forms of migraines

Additional and Relevant Useful Information for Migraine with Brainstem Aura:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/neurological-institute/