Basilar-Type Migraine - The Basics

by Teri Robert, Lead Expert

Important Note: Due to changes in the International Headache Society's International Classification of Headache Disorders (ICHD), this form of migraine is now called migraine with brainstem aura. This article has been replaced by Migraine with Brainstem Aura - The Basics.

Key Points:

  1. A Migraine-type defined by the presence of Migraine headache with neurological symptoms which begin either in the base of the brain or from both sides of the brain at the same time; i.e. brainstem or both cerebral hemispheres. 
  2. Many compare this Migraine type more to hemiplegic Migraine (Migraine type with weakness) than to Migraine with typical aura (99% visual symptoms). Those with less understanding of this Migraine consider it as “atypical or complicated” aura.
  3. All patients describe visual symptoms, nearly 2 of 3 sensory and least often language or aphasic aura. Vertigo is the most frequent symptom type.
  4. In actuality, nearly all basilar-type Migraineurs suffer typical Migraine with aura as well; just more frequent sensory and speaking difficulties of longer duration and intensity.
  5. Obtain a correct diagnosis, optimal treatment plan, and prevent as many Migraines as possible to reduce disability and improve prognosis.

If you've heard of this type of Migraine before, you've probably heard or seen the term basilar artery Migraine (BAM). Under the International Headache Society's International Classification of Headache Disorders-2004, the new designation for this type of Migraine is basilar-type Migraine (BTM). It has also been called Bickerstaff syndrome, brainstem Migraine, and vertebrobasilar Migraine. The term BAM is actually misleading as it implies that the basilar artery is the origin of the attack. It was termed basilar by Bickerstaff in 1961-62. He reported his beliefs that the events of BTM were the result of short term narrowing or spasm of the basilar artery. Reduced blood flow or “ischemia” followed and was believed to increase risk for serious events. This belief remained a concern for over 3 decades. It even resulted in the exclusion of BAM patients from clinical trials of triptans for Migraine. The absence of BAM patients in trials led the Federal Drug Administration (FDA) to contraindicate use of triptans in patients with BAM.

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