Basilar Migraine

Basilar migraine is a rare type of headache that has visual auras, vertigo and other atypical headache symptoms. It is also called basilar artery migraine and it can have frightening symptoms. This pain is unlike usual migraines. The pain is usually severe, throbbing at localized at the back of the head.

It may be accompanied by severe vertigo (the sense that the room is spinning), difficulty walking and most commonly, visual disturbances.

Now what do I mean by visual disturbances? Well, just about anything from blurry vision to blindness. This is caused by the fact that the basilar artery, where the problem is happening, is located in the back of the head.

This artery feeds blood and oxygen to the back of the brain where the visual centers are located..if you have a problem in that area it definitely affects your vision.

Other common migraine headache symptoms may also occur such as nausea, vomiting and having the light and sounds bother you. Rarer symptoms are jerking movements of the eyes, ringing in the ears and loss of consciousness. Vertigo is quite common and can be disabling.

  • Why Is This Serious?

A basilar migraine can increase the risk of stroke. Although a neurovascular condition like all other migraines, one of the problems is that aneurysms (an outpouching of the artery) may occur in this area.

If caught, aneurysms are generally followed with more imaging such as a CT angiogram which gets a much better look at it. Surgery is recommended to "clip" it when it gets to a certain size.Inserting a coil or a stent is also an option but it depends on the aneurysm. For cerebral aneurysms the limit is usually 10mm although some surgeons have told me they will do the procedure on a smaller one if the patient has neurological symptoms. Usually if under 5mm they tend to watch and wait which means MRI's and MRA's every few months. Below is an MRI of a basilar aneurysm. This particular one was in a patient who was only 36, but had a history of smoking 2 packs per day.

basilar aneurysm

  • Testing For Basilar Migraine

If you present to a doctor with the symptoms of basilar migraine, unfortunately since it mimics a stroke so closely, be prepared for a bit of a full work up to rule out stroke.

This most probably will include an MRI or CT of the brain right away and possibly an MRA to look at the arteries of the brain. Again this would not only find a stroke but also find an aneurysm.

A full examination including some testing for vertigo and hearing (if necessary) should be performed.

If the doctor is suspicious about possible seizures (they sometimes present with vertigo and headache) then an EEG is necessary. This is just a study to look at the electrical waves in the brain and involves wearing some scalp electrodes and getting your hair messed up!

  • Treatment

Once a stroke has been ruled out, treatment is pretty straight forward. If the headache is disabling and occurs a couple of times a month, then you need to be on daily therapy for awhile, perhaps a few months to a year.

While many preventative medications for migraine are familiar to most headache sufferers, the drug of choice for this type of headache is verapamil taken once or twice a day.

If you cannot take this medication, a beta-blocker such as Inderal is a good choice also.

If an attack does occur, most people can manage it well with a small dose of a pain killer. Many people also wonder why they cannot take their usual medications for migraine but unfortunately, all triptans such as Imitrex, are contra-indicated for this.

Take heart! New treatments and research are always coming up. This issue may change in the future with more research on basilar migraine.

If the above symptoms do not sound like yours, read more about different types of headaches.

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