Basilar migraines (Basilar type migraine)

Basilar migraines, now more properly called basilar-type migraine, are known for their strange aura symptoms (other names that have been used: basilar artery migraines, basilar migraine headache).

Sometimes the strange visual aura can be two sided, and can be so bad it leads to temporary blindness.  It's usually followed by incoordination (ataxia), double vision, vertigo (more on basilar migraines and vertigo), ringing in the ears, jerky eye movements, trouble hearing, slurred speech, dizziness, and more severe versions of other migraine symptoms, such as nausea, prickly feelings on the body, sensitivity to

light and/or sound, and trouble thinking clearly.  This stage of the attack usually lasts about 5-60 minutes, but can last days in some cases.  Worse, these symptoms can come in succession - several one after the other!

Usually there's a severe throbbing headache at the back of the head on both sides (as opposed to the more common migraine symptom of one-sided headache, often in the temples).

Unlike types of hemiplegic migraine, basilar-type migraine does not involve motor weakness.

Where do basilar migraines come from?

The basilar artery is in the back of your head, and it was once believed that the basilar artery migraine had its start in the basilar artery.  Many years ago researchers thought that the main roots of migraine in general came from the expanding and contracting of blood vessels.  Today, researchers are looking more at neurological causes.  And so the so-called basilar artery migraines likely don't start in the artery at all, but have their roots in the other chemicals sending messages throughout your brain.  As with other types of migraine, the specifics of what is taking place are still somewhat of a mystery. (See the US National Headache Foundation article on basilar migraines)

The unique feature of BTM is that it seems to occur either in the brain stem or both cerebral hemispheres.  This impacts the way the attack happens, and how we treat it (see below).

For now, generally speaking what was once called a basilar artery migraine or BAM is now basilar-type migraine.  Because the attack doesn't come from the artery, don't be surprised if this name is soon dropped also (see Basilar-type migraine by Dr. David F. Black (2008)).

Doctors are concerned about these symptoms for a couple of reasons.  First, the symptoms are the same as some much more serious conditions, so you'll want to make sure to see a doctor right away if these symptoms are new to you.  Your doctor may order a CT or MRI, and possibly an EEG, to rule out other possibilities (see Do I need an EEG?).

Second, there is concern that those with basilar migraine may be at greatly increased risk of stroke.  Basilar migraines are rare, and even if this describes you, they are not a reason to panic.  But do see a doctor to make sure you're keeping your risk as low as possible.

What's the treatment?

Because this type of migraine is so rare, there has been less research done specifically on them.  Although the treatment is often similar to other types of migraine, there are some differences.

Abortive medications such as triptans and ergotamines are usually not used (though some researchers suggest this should be rethought).  For prevantative migraine medication, beta-blockers are also usually avoided.

Check here for more about migraine treatments.

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Check out this article for more on "eye migraines" of various kinds, or click here to read about other types of headache.

Special thanks to Dr William B Young and Dr Stephen D Silberstein for their book “Migraine and other Headaches”. These guys really take the time to explain these crazy symptoms and give us a full overview of what treatments are out there, not just their favourites. Thanks!

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