What is basilar migraine?

Updated: Oct 16, 2019
  • Author: Rima M Dafer, MD, MPH, FAHA; Chief Editor: Helmi L Lutsep, MD  more...
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Patients with basilar migraine (also known as Bickerstaff syndrome) usually present with symptoms of vertebrobasilar insufficiency, which may precede a headache. The most common symptoms are dizziness and vertigo, but symptoms may also include headache accompanied by ataxia, tinnitus, decreased hearing, nausea and vomiting, dysarthria, diplopia, loss of balance, bilateral paresthesias or paresis, altered consciousness, syncope, and, sometimes loss of consciousness. [42]

Basilar migraine is observed most frequently in adolescent girls and young women. [43] Localized vertebrobasilar vasoconstriction leading to transient posterior circulation ischemia may contribute to the symptoms of the disorder. [44] A novel mutation in the ATP1A2 gene, similar to that seen in familial hemiplegic migraine (FHM), has been reported in members of a family with basilar migraine.

The differential diagnosis includes various causes of syncopal, inner-ear, intoxication, and posterior-fossa pathologies. [45] However, the yield for diagnostic testing is low. Transient abnormalities on computed tomography (CT) and magnetic resonance imaging (MRI) have been reported during or immediately after attacks. Single-photon emission CT (SPECT) studies suggest decreased regional cerebral blood flow in the posterior circulation during attacks, but transcranial Doppler ultrasonography has not revealed changes in blood flow velocities.

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