May 11, 2015: Basilar-type migraine

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May 11, 2015

Basilar-type migraine

Migraine headache is a common primary headache syndrome, affecting upwards of 12% of the population. Basilar-type migraine, or migraine with brainstem aura, is felt to be a subset of typical migraine with aura. Theories speculate that the aura associated with this type of migraine is secondary to cortical spreading, affecting the brainstem or bilateral cerebral hemispheres. Bickerstaff initially termed this basilar artery migraine, although no clear association or vasculopathy of the basilar artery has been proven to date. Typical symptoms include brainstem findings of dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia, or diminished consciousness, with vertigo and dysarthria being most common. Diagnosis can be difficulty given the similarity to stroke, TIA and posterior fossa disease. MRI and MRA imaging should be used to exclude a vascular lesion or brainstem pathology.


  1. Evans RW and Linder SL. Management of basilar migraine. Headache 2002; 42: 383-384.
  2. The International Classification of Headache Disorders, 3rd edition (beta version). Headache Classification Committee of the International Society (IHS). Cephalgia. 2013; 33: 629-808.

Submitted by James Addington, M.D. Resident Physician, Department of Neurology, University of Virginia

Disclosures: Dr. Addington is a member of the Residents & Fellows Section of Neurology.

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