Migraine with BrainStem Aura

Previously known as Basilar-type migraine, Migraine with brainstem aura (MBA) presents with characteristic symptoms such as vertigo, dysarthria, tinnitus, diplopia, bilateral visual symptoms, or bilateral paresthesias. This is an uncommon subtype of migraine with aura. It is believed that the neuronal dysfunction of the brain stem can lead to subsequent stimulation of the trigeminal nerve triggering neurogenic inflammation and pain. A notable difference between MBA and migraine with typical aura is the symptoms involving the brainstem or the bilateral occipital hemispheres, whereas typical migraine with aura is mainly restricted to a unilateral hemisphere. Neuroimaging is suggested for all patients with first-ever MBA symptoms to exclude alternative etiologies. Triptans and Ergotamine derivatives are generally felt to be contraindicated in MBA because of the potential for cerebral vasoconstriction, but this is based on outdated vascular theory of migraine and should be reconsidered. Further discussion with your neurologist is needed to determine the appropriate treatment for your MBA.

Yamani N, Chalmer MA, Olesen J. Migraine with brainstem aura: defining the core syndrome. Brain. 2019 Dec 1;142(12):3868-3875. doi: 10.1093/brain/awz338. PMID: 31789370.

By: Andrew Chan, PA