Migraine with Brainstem Aura (MBA)

‍Migraine with brainstem aura (MBA), formerly known as basilar migraine, is a rare form of migraine that starts at the lower part of the brain, the brainstem. Originally thought to occur during a spasm of the basilar artery at the back of the brain, it is now believed to be caused by a firing of nerves in the brainstem. 

What Are the Symptoms?

MBA is a subtype of migraine with aura, a recurring headache that strikes after or during the sensory disturbances of aura. Aura, which tends to last for about 60 minutes, is indicated if two or more of these symptoms are present:

  • dizziness (vertigo)
  • slurring of speech (dysarthria)
  • ringing in the ears (tinnitus)
  • double vision (diplopia)
  • unsteadiness when walking (ataxia)
  • a decreased level of consciousness

About 75% of people affected by aura develop a migraine headache in the back of the head after it, often described as throbbing. They may also experience other symptoms of aura and migraine, including nausea and vomiting, light and sound sensitivity, blind spots (scotomas) and zigzag lines in their vision, and sensations of numbness.

What Causes It?

Typical migraine with aura is thought to be caused by high-intensity nerve firing that spreads from part of the brain. This firing rapidly uses energy and creates accumulated toxins, all of which depress brain activity and likely trigger the sensory phenomena associated with migraine.

How Is It Diagnosed?

To carefully assess an affected person for an underlying cause, specialists may call for imaging of the brain and vessels in the head, or an EEG to eliminate a potential seizure disorder. They will also assure that the individual doesn’t have a separate headache disorder that is similar to MBA, such as hemiplegic migraine and migraine with typical aura.

How Is It Treated?

To treat MBA symptoms, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium, as well as antiemetic medication to relieve nausea and vomiting, such as prochlorperazine or metoclopramide. 

Is It Preventable?

As a preventive treatment, the doctor may prescribe verapamil (used successfully to treat hemiplegic migraine, which has similar symptoms) or topiramate, which is reported to significantly reduce overall migraine and MBA frequency.

What Are the Symptoms?

MBA is a subtype of migraine with aura, a recurring headache that strikes after or during the sensory disturbances of aura. Aura, which tends to last for about 60 minutes, is indicated if two or more of these symptoms are present:

  • dizziness (vertigo)
  • slurring of speech (dysarthria)
  • ringing in the ears (tinnitus)
  • double vision (diplopia)
  • unsteadiness when walking (ataxia)
  • a decreased level of consciousness

About 75% of people affected by aura develop a migraine headache in the back of the head after it, often described as throbbing. They may also experience other symptoms of aura and migraine, including nausea and vomiting, light and sound sensitivity, blind spots (scotomas) and zigzag lines in their vision, and sensations of numbness.

What Causes It?

Typical migraine with aura is thought to be caused by high-intensity nerve firing that spreads from part of the brain. This firing rapidly uses energy and creates accumulated toxins, all of which depress brain activity and likely trigger the sensory phenomena associated with migraine.

How Is It Diagnosed?

To carefully assess an affected person for an underlying cause, specialists may call for imaging of the brain and vessels in the head, or an EEG to eliminate a potential seizure disorder. They will also assure that the individual doesn’t have a separate headache disorder that is similar to MBA, such as hemiplegic migraine and migraine with typical aura.

How Is It Treated?

To treat MBA symptoms, the doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium, as well as antiemetic medication to relieve nausea and vomiting, such as prochlorperazine or metoclopramide. 

Is It Preventable?

As a preventive treatment, the doctor may prescribe verapamil (used successfully to treat hemiplegic migraine, which has similar symptoms) or topiramate, which is reported to significantly reduce overall migraine and MBA frequency.

Sources

  1. Neurology. Basilar-type migraine: clinical, epidemiologic, and genetic features. https://pubmed.ncbi.nlm.nih.gov/16567706/
  2. Nature. Cortical spreading depression and migraine. https://www.nature.com/articles/nrneurol.2013.192
  3. Cephalalgia. Migraine with brainstem aura: Why not a cortical origin? https://pubmed.ncbi.nlm.nih.gov/29073774/
  4. UpToDate. Migraine with brainstem aura. https://www.uptodate.com/contents/migraine-with-brainstem-aura
  5. Headache. A double-blind, dose comparison study of topiramate for prophylaxis of basilar-type migraine in children: a pilot study. https://pubmed.ncbi.nlm.nih.gov/18052950/
  6. American Migraine Foundation. Migraine with Brainstem Aura (Basilar Migraine). https://americanmigrainefoundation.org/resource-library/migraine-with-brainstem-aura

Still need help?

We try to maintain a comprehensive set of materials for various audiences. However, we realize that often there are questions that remain unanswered. We're here to help!
Be the first to know about the latest advancements in migraine care.
Thank you.
We promise we won't spam.
Oops! Something went wrong.
No items found.