Migraine with brainstem aura (MBA) is a type of migraine that begins in the brainstem and includes aura, or preceding symptoms like vertigo, speaking and hearing difficulty, and loss of muscle control.
Previously, this type of migraine has been referred to as basilar migraine or basilar artery migraine. The International Headache Society now classifies it as “migraine with brainstem aura.”
This type of migraine has been known for half a century, but it’s still something of a mystery. It’s very rare, its cause is unknown, and its diagnosis and even its existence are still questioned.
Migraine with brainstem aura is considered a type of migraine with aura. This means the migraine can have symptoms that affect your senses, especially your sight. “Aura” is a medical term referring to the collection of symptoms preceding a migraine attack.
With MBA, you might see spots or lines in your vision, as well as abnormal flashes of lights. During these disturbances or soon after, you usually get head pain, but not always.
Migraine with brainstem aura is relatively rare. Recent research shows that they affect .04 percent of the general population, 1.6 percent of people with headaches, and 10 percent of people who have migraine with visual aura.
This type of migraine usually lasts for only an hour or so. Severe MBAs may last for a few hours, but they’re not usually the result of any serious condition.
With treatment and an understanding of potential causes, MBAs can be managed without interrupting your daily life.
With this kind of migraine, you’ll likely experience many of the common symptoms of classic migraine with aura, such as:
- seeing lights flashing in your vision (with no external source)
- seeing spots, stars, or lines in your vision
- losing full vision or seeing “static”
- feeling numb in your face, hands, or head
- feeling abnormally weak or exhausted
Because this type of migraine starts in your brainstem, you may have symptoms on one side or both sides of your body. Symptoms that are specific to an MBA may include:
- feeling nauseous
- feeling as though your surroundings are spinning, to the point where you may not be able to stand up straight (known as vertigo)
- having double vision (not able to focus your eyes or seeing two of everything)
- feeling confused or disoriented
- not being able to speak or pronounce words properly (slurred speech)
- changes in your ability to hear (such as hearing ringing in your ears, which is called tinnitus)
- having an extremely painful headache
- not being able to control your muscles (known as ataxia)
- blacking out and losing consciousness
If you have one or more of these symptoms, speak with your doctor as soon as possible for a diagnosis and to rule out any more serious causes.
Vertigo is one of the symptoms of the aura that often precedes a migraine attack with brainstem aura.
Vertigo is a sense of movement when no movement exists. It’s also described as spinning, rocking, or pitching forward.
The vertigo associated with migraine with brainstem aura (previously known as basilar migraine vertigo) usually lasts only a short time, from several minutes up to an hour. It’s possible to have aura symptoms without head pain following it.
When vertigo is the primary symptom of the migraine attack, it’s often referred to as a vestibular migraine. This type of migraine commonly doesn’t involve head pain but can be very disorienting.
Symptoms of a vestibular migraine usually subside in minutes up to several days.
When you have aura symptoms without head pain, it’s called a 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 make sure these symptoms aren’t caused by a more serious underlying condition.
Is migraine with brainstem aura related to strokes?
The symptoms of a stroke and migraine with brainstem aura can be similar. As a result, people sometimes worry they are having a stroke when they have this type of migraine attack.
Research indicates that 2 percent of people initially evaluated as having a stroke during emergency treatment are eventually diagnosed with migraine.
Conversely, because a stroke usually includes intense head pain, people sometimes think they’re having a migraine attack when they’re really having a stroke.
Medical professionals advise getting emergency care immediately if you have any doubt about whether you’re experiencing migraine or stroke.
Symptoms such as visual disturbances, numbness, and speech difficulties can be part of either migraine brainstem aura or a stroke.
A migraine with brainstem aura attack is most apt to mimic a type of stroke called a transient ischemic attack (TIA). A TIA is sometimes called a ministroke. It usually lasts less than 24 hours and doesn’t cause lasting damage to the brain.
Some people worry that their migraine attack will turn into a stroke. While migraine and stroke do happen at the same time for some people, no research confirms that one causes the other.
There’s also little evidence indicating that strokes are more common during migraine attacks than at other times.
When a stroke and a migraine attack do occur at the same time, it’s referred to as a migrainous stroke, or migrainous infarction. By definition, this type of stroke only occurs in tandem with migraine involving aura or preceding symptoms.
Migrainous strokes make up less than 1 percent of all strokes. As with all strokes, it’s important to get immediate emergency care.
Though the relationship between migraine and stroke isn’t entirely understood, doctors do know that people with a history of migraine with aura are about twice as likely to have strokes as those without a migraine history.
Is migraine with brainstem aura related to seizures?
Seizures and migraine are sometimes thought to go hand in hand. They often occur together, and their symptoms can be similar. However, research doesn’t show that one causes the other for the most part.
Migraine aura triggered seizure
There is, however, a specific migraine and seizure disorder called a migraine aura triggered seizure. The International Classification of Headache Disorders 3rd edition (ICHD-3) classifies as a seizure triggered by an attack of migraine with aura.
The criteria for diagnosis includes all of the following:
- a seizure diagnosed as a type of epileptic attack
- a seizure occurring in someone living with migraine with aura
- the seizure occurs during or within 1 hour after an episode of migraine with aura
This phenomenon is sometimes referred to as migralepsy and is rare.
Symptom overlap between seizures and migraine
According to the Epilepsy Foundation, people with seizure disorders are twice as likely to have migraine. Also, people with migraine are more likely to have epilepsy.
The symptoms of a seizure aura can be similar to those of a migraine with brainstem aura. For instance, if a person has sudden numbness in the face and arm, it might be caused by either a seizure or an MBA.
Because of shared symptoms, MBA and seizures are sometimes misdiagnosed as each other. An electroencephalogram (EEG) is sometimes used to rule out a seizure.
Some of the same triggers that bring on MBAs are thought to bring on seizures as well. These include:
Scientists don’t yet understand the link between migraine and seizures. It may be that one causes the other in a way not yet understood.
The link also may be genetic, environmental, or simply the result of both disorders being brought on by similar triggers.
The International Headache Society classification system published in 2018 gives specific guidelines for a diagnosis of migraine with brainstem aura.
For an MBA diagnosis to be made, two episodes must occur 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 ability to produce speech
- hearing disruption
- double vision
- inability to control body movements
- decreased level of consciousness
There are no medical tests that can confirm a diagnosis. As a result, tests are sometimes given to rule out other conditions. For example, an EEG may be conducted to rule out a seizure, or a CT scan and MRI Brain may be used to rule out a stroke.
Diagnosing an MBA can be challenging. Researchers point out that migraine attacks can be “mimics” of other conditions, as well as “chameleons” whose symptoms are similar to those of other conditions.
As a result, migraine attacks are sometimes investigated as other conditions, and other conditions can be mistakenly investigated as migraine.
It’s important when you’re being evaluated by medical professionals to give a clear description of your symptoms and health history.
Taking certain medications can reduce the frequency and severity of your migraine attacks. Common treatments for migraine with brainstem aura include:
It’s important to note that some migraine medications such as triptans are not recommended to help prevent MBAs because these drugs constrict your brain’s blood vessels.
These medications can have some side effects and may interact with existing medications or with your diet. Talk with your doctor about which medication may work best for you.
Migraine doesn’t always have a traceable cause, so treating the underlying causes of migraine can be difficult.
Treating the symptoms of migraine with brainstem aura is the most effective way of relieving the pain and discomfort that goes along with having a migraine attack.
Abortive medications to treat acute attacks
Some common medications to reduce migraine with brainstem aura symptoms (as well as those of other migraine with aura) include:
- nonsteroidal anti-inflammatory drugs (NSAIDs) for relieving headache pain, such as ibuprofen (Advil)
- small molecule CGRP antagonists such as rimegepant (Nurtec) and ubrogepant (Ubrelvy)
- antinausea medications, such as metoclopramide (Reglan)
Diet and lifestyle changes
Lifestyle changes can also help treat migraine, including the following:
- Sleep regularly for 6 to 8 hours per night. This amount of sleep may help stop frequent migraine attacks.
- When you first notice symptoms of migraine attack, stop what you’re doing. 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 cut them out altogether.
Scientists are also exploring possible genetic causes. They don’t generally believe that migraine with brainstem aura is inherited. MBAs may be caused by a change, or mutation, in the ATP1A2 gene or CACNA1A gene.
Although the exact causes of migraine with brainstem aura are not known, scientists do agree that environmental and lifestyle triggers can bring on this type of migraine attack.
According to research published in the journal Pain Medicine, emotional situations (74 percent) and sleep disorders (65 percent) are the most common triggers of MBAs.
Other common triggers include:
- changes in weather or altitude
- fatigue/lack of sleep
- motion sickness
- bright or flashing lights
- strong smells
- certain medications, such as for birth control or blood pressure
- certain foods and beverages, such as those containing caffeine or alcohol
- experiencing an epilepsy seizure
MBA attacks occur most frequently in teenagers and young adults. According to the Genetic and Rare Disease Information Center, this kind of migraine is most common in adolescent women.
Living in environments with sensory triggers can increase your risk, too. If smells, recurrent weather changes, bright lights, or stress trigger your migraine attack, you may want to consider relocating to a different environment with fewer of these triggers.
Migraine with brainstem aura can often be treated at home with over-the-counter medications, rest, and diet and lifestyle changes.
But if your symptoms limit your ability to do daily tasks, or if migraine attacks have caused you to pass out, see your doctor right away or go to a nearby emergency room for treatment.
You can find out whether your symptoms are being caused by a more serious condition, or by an MBA. If it’s an MBA, you can get help dealing with what can be an unsettling but very treatable condition.