Chapter 1, Episode 9: What is Migraine with Brainstem Aura?


This content has been medically reviewed by Dr. Larry Charleston.

Migraine with brainstem aura, formerly known as basilar migraine, is a rare type of headache that starts in the brainstem, or lower part of the brain

According to the International Headache Society, diagnostic criteria requires two of the following symptoms: vertigo, double vision, hearing loss, slurred or slow speech, ringing in the ears, impaired coordination or decreased level of consciousness. These symptoms can last anywhere from a few minutes to over an hour and must be fully reversible to be considered migraine with brainstem aura. It is usually followed by nausea and/or a throbbing headache. 

Motor and retinal symptoms, such as muscle weakness or seeing spots or zigzags, are NOT experienced in migraine with brainstem aura. However, a person with migraine with brainstem aura can experience these symptoms if they also have migraine with aura.

Migraine with brainstem aura is diagnosed after ruling out other causes such as a seizure, stroke, transient ischemic attack and hemiplegic migraine. Diagnostic tests to rule out other conditions may include an electroencephalogram, CT scan and/or MRI.

Cortical spreading depression is thought to be one possible cause of migraine with brainstem aura. Cortical spreading depression is a wave of activity that slowly moves across the brain dramatically impacting neural and vascular function. For migraine with brainstem aura, cortical spreading depression is thought to originate in the brainstem or bilaterally from the cerebral cortex. This is why many people will experience symptoms on both sides of the body with migraine with brainstem aura.

This condition can affect any age group but it most commonly occurs in females and in adolescents and young adults. Although it is thought migraine with brainstem aura is not inherited, many people with this condition will report a family history of headaches or migraine. In rare cases, gene mutations may cause susceptibility to migraine with brainstem aura. 

Triggers are the same as typical migraine, with emotional influences and sleep disruptions being two of the most common.

Migraine with brainstem aura is typically treated with traditional migraine medications. NSAIDs and anti-nausea medications are commonly used. Until recently, triptans and ergot alkaloids were not recommended for acute treatment of migraine with brainstem aura, however, new research suggests these options may be safe.

Verapamil, topiramate, and lamotrigine are the most commonly prescribed preventive medications for migraine with brainstem aura.

While most traditional migraine treatments can be used, some believe beta-blockers should be avoided due to rare, potential complications.

This video is sponsored in part by Amgen and Teva Pharmaceuticals.



*The contents of this video are intended for general informational purposes only and does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. AMD does not recommend or endorse any treatment, products, or procedures mentioned. Reliance on any information provided by this content is solely at your own risk.