Of the preventive medications, there is some evidence in children for topiramate success. Many use a calcium channel blocker with benefit although this is based on experience only. Otherwise, BTM is generally managed with traditional preventatives although many recommend that beta blockers be avoided due to rare reports of complicating events.
Disability and Prognosis
As with other forms of Migraine, BTM can be disabling. Because of the neurological symptom types, with vertigo the most frequent, BTM is often more debilitating than Migraine with aura due to aura intensity, number of symptoms and longer length. Perhaps fortunately, the majority of BTM patients are older children, adolescents or young adults. Basilar-type Migraine can mean special problems for people in the traditional work force or trying to care for young children. For many, however, aura in BTM commonly becomes more typical during later mid-life. While disabling, symptoms of BTM are usually more frightening than harmful. A concern or myth about stroke risk has existed for decades. There is no evidence that BTM patients have any greater stroke (cerebrovascular) risk than Migraine with typical aura. Migraine with aura does have a slightly higher stroke risk than Migraine without aura in those younger than 45, so optimal prevention and knowledge of stroke risk factors and their control is important. As a BTM patient, if others are not educated about BTM, it is particularly important that efforts be made to inform them.
Basilar-type Migraine is one type of Migraine with aura; it is one of the most frightening of head pain disorders. As with other forms of Migraine, it is necessary to have an accurate diagnosis and effective treatment plan. This requires use of that treatment as early as possible when pain is mild without waiting to learn how extreme the pain will become. Severe BTM will often require seeking emergency care. Unfortunately, ED/ERs will often fail to consider BTM as your diagnosis. It may be reasonable that BTM sufferers have medical identification of some kind on their person; consider a Medical ID as important. If providers do consider it, they typically will not know how to treat it. Access to a Migraine and headache specialist is also important. Once diagnosed with BTM, it is important (as with any form of Migraine) to minimize the frequency of attacks through optimal prevention. Also contact your provider if your symptoms or Migraine pattern change. Without consulting a knowledgeable provider, it's impossible to be sure that new symptoms or changes in pattern are attributable to BTM, and that no other condition is present. While BTM isn't cause to panic, be sensible and take good care of yourself.
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Edited by Frederick R. Taylor, MD August 14, 2010
Medical review by John Claude Krusz, PhD, MD