Migraine with brainstem aura, previously called basilar migraine, is a rare type of migraine that causes aura symptoms, like vertigo, slurred speech, and tinnitus, without motor weakness.
Migraine with brainstem aura (MBA) is a type of migraine that begins in the brainstem and includes aura with symptoms like vertigo, speaking and hearing difficulty, and loss of muscle control.
Doctors previously called this type of migraine basilar migraine or basilar artery migraine. Newer research suggests that it likely is not due to basilar artery spasms, but many people may still use the old term.
While scientists have known about this type of migraine since
Keep reading to learn more about MBA, its symptoms, treatment, and the diagnostic challenge it may present for doctors.
MBA is a type of migraine with aura. This means the migraine can have symptoms that affect your senses, especially your sight. “Aura” refers to the collection of symptoms usually preceding headache pain, though they can sometimes continue during the pain phase.
With MBA, you’ll likely experience many of the common symptoms of migraine with aura, such as:
- seeing lights flashing in your vision (with no external source)
- seeing spots, stars, or lines in your vision
- vision loss or seeing “static”
- numbness in your face, hands, or head
- fatigue
Because this type of migraine starts in your brainstem, you may have symptoms on one or both sides of your body. Symptoms specific to an MBA episode may include:
- nausea
- vertigo (feeling as though your surroundings are spinning)
- double vision (not able to focus your eyes or seeing two of everything)
- confusion or disorientation
- slurred speech
- changes in your ability to hear, including tinnitus (ringing in your ears)
- an extremely painful headache
- ataxia (reduced muscle control)
- decreased of consciousness
If you have one or more of these symptoms, speak with a doctor as soon as possible for a diagnosis and to rule out any more serious causes.
How long does basilar migraine last?
Auras from MBA typically last
To diagnose MBA, a doctor will consider your symptoms. You must have had two episodes that include at least two of the following brainstem aura symptoms. Most MBA attacks involve other aura symptoms as well, but these are the distinguishing symptoms:
- impaired speech
- vertigo
- tinnitus
- hearing disruption
- double vision
- ataxia
- decreased level of consciousness
Your aura must also exclude motor or retinal symptoms. Prolonged motor symptoms may suggest hemiplegic migraine, while retinal symptoms (like visual changes that affect only one eye) may suggest retinal migraine.
No medical tests can confirm an MBA diagnosis, but doctors may use them to rule out other conditions. For example, a doctor may conduct an electroencephalogram (EEG) to rule out a seizure, or an MRI or CT scan to rule out a stroke.
Basilar migraine vs. vestibular migraine
Vertigo, a spinning sensation and loss of balance, is a hallmark symptom of basilar migraine. It’s also a notable symptom of vestibular migraine.
The International Headache Society notes that while most people with MBA experience vertigo, most people who experience vertigo as part of a migraine episode do not meet the full criteria for MBA. They may, however, meet the criteria for vestibular migraine.
Another key difference is that most people with vestibular migraine don’t experience vertigo as part of aura but as a primary symptom of another migraine phase.
Migraine doesn’t always have a traceable cause, so treating the underlying cause can be difficult.
Treating the symptoms of MBA is the most effective way of relieving the pain and discomfort that goes along with having a migraine attack.
Medications to treat acute attacks (abortive)
Some common medications to reduce MBA symptoms
- nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen (Advil), for relieving head pain
- small molecule CGRP antagonists, like rimegepant (Nurtec) and ubrogepant (Ubrelvy)
- antiemetics, like metoclopramide (Reglan)
Experts do not recommend other traditional migraine medications, like triptans and ergotamines, for MBA, as they can increase the risk of stroke in this population.
Medications to prevent attacks (preventive)
Taking certain medications can reduce the frequency and severity of your migraine attacks. Common preventive treatments for MBA
- calcium channel blockers, like verapamil (Verelan)
- anticonvulsants, like topiramate (Topamax)
- antidepressants, like amitriptyline
These medications can have side effects and may interact with existing medications or your diet. Talk with your doctor about which medication may work best for you.
As with abortive medications, some common preventive medications are also not recommended for people with MBA. Doctors generally avoid prescribing beta-blockers for people with MBA as they can affect blood flow to the brain.
Diet and lifestyle changes
Lifestyle changes can also help treat or prevent migraine, including the following:
- Sleep regularly for 6 to 8 hours per night.
- Stop what you’re doing when you first notice symptoms of a migraine attack. Try to stay in a dark room with minimal interruption, and put an ice pack on the back of your neck. These measures may prevent the onset of severe symptoms.
- Allow yourself to take a break and relax when you feel migraine symptoms coming on. This may keep your migraine from getting worse after it starts.
- Eat and drink less of any foods and beverages that seem to trigger your migraine. Once you’ve identified your trigger foods and drinks, cut down on them or avoid them altogether.
Experts
Scientists are also exploring possible genetic causes. They don’t generally believe that MBA is inherited, but mutations in the ATP1A2 or CACNA1A genes may increase risk.
Although the exact causes are unknown, scientists do agree that environmental and lifestyle triggers can bring on this type of migraine attack, including:
- changes in weather or altitude
- stress
- fatigue or lack of sleep
- motion sickness
- bright or flashing lights
- strong smells
- certain medications, such as for birth control or blood pressure
- certain foods, like cheese
- certain beverages, such as those containing caffeine or alcohol
- certain preservatives, like MSG
Who is most likely to develop basilar migraine?
MBA is more common in females, and attacks occur most frequently in teenagers and young adults.
Migraine is a chronic condition, though some people get fewer and less severe episodes as they age, according to the American Headache Society.
With treatment and an understanding of potential triggers, you can manage MBA without interrupting your daily life.
Is basilar migraine dangerous?
While MBA episodes can be debilitating, they don’t typically lead to severe complications. However, if you lose consciousness during a severe episode, you could sustain a fall.
Is basilar migraine a disability?
The Social Security Administration may consider MBA a disability if it affects your ability to work long-term. Learn more about migraine and disability benefits.
Can you have basilar migraine without head pain?
You can have aura symptoms without head pain, which people sometimes call silent migraine. The aura symptoms aren’t usually a cause for concern, but they can disrupt daily life.
Silent migraine attacks can be unsettling, especially if the aura symptoms are severe. It’s always good to check with a medical professional to ensure these symptoms aren’t due to a more serious underlying condition.
MBA, previously called “basilar migraine,” is a type of migraine in which you experience brainstem aura symptoms like vertigo, slurred speech, or ringing in your ears. You can often treat MBA at home with over-the-counter medications, rest, diet, and lifestyle changes.
If your symptoms limit your ability to do daily tasks, or if migraine attacks have caused you to pass out, see a doctor right away or go to a nearby emergency room for treatment. You can find out whether your symptoms are due to MBA or a more serious condition.