Basilar Artery Migraine: a Follow‐up Study of 82 Cases

Abstract

SYNOPSIS 82 adolescent or adult patients in whom the diagnosis of basilar artery migraine (BAM) had been made or suspected were reviewed. When rigorous criteria were used, the diagnosis could be confirmed in 49 patients (32 women and 17 men). Seven other patients probably had BAM, but did not totally fulfill the criteria. In 26 cases reevaluation did not confirm the diagnosis. In the 49 patients with definite BAM the age of onset ranged from 10 to 62 years, 65% of them having their first attack in the second or third decade. 40% had BAM attacks only, while 60% had additionally other types of migraine attacks. A typical pattern of attacks with an “ischemic” aura followed by predominantly occipital headache was found in only 57%. The most frequent “ischemic” symptom was bilateral visual impairment (86%). Symptoms and signs of brain stem dysfunction were vertigo (63%), gait ataxia (63%), bilateral paresthesia (61%), bilateral weakness (57%), and dysarthria (57%). 77% of the cases had disorders of consciousness (mainly syncope, confusion and prolonged amnesia). 4 patients (8%) had epileptic seizures during the migraine attacks. 73% had a family history of migraine and 12% of epilepsy. EEG's were always abnormal during the attacks with predominantly localized or generalized mostly paroxysmal slow wave activity. CT scans were normal except for 2 women with repeated BAM attacks, who were smokers and taking contraceptive drugs, and who during an attack experienced a cerebellar and an occipital lobe infarction respectively. Of the 26 patients in whom the diagnosis of BAM could not be confirmed 13 had other types of migraine, while the remaining cases had temporal lobe epilepsy, intermittent vertebral basilar artery insufficiency, orthostatic hypotension or hysterical attacks.

Migraine-related vertigo: Diagnosis and treatment

“…Aural fullness may occur in 43% [16•] to 56% [25] and be unilateral or bilateral. Several case series have demonstrated an association between migraine and hearing loss [26, [28][29][30][31]. Olsson [26] found some type of low-frequency hearing loss in 80% of basilar migraine patients (bilateral in 46% and unilateral in 34%), although other studies suggest hearing loss occurs less often, is mild, and is nonprogressive [25].…”

Vestibular migraine

“…Headaches usually were bilateral with pain located in the occipital region. The most common symptoms in basilar-type migraine include the bilateral visual disturbances, changes in consciousness, vertigo, changes in mood, and bilateral sensory changes [8,9]. Many authors have described cases of episodic vertigo in migraine, supporting the Vestibular symptoms such as vertigo and dizziness are quite common in migraine.…”

Fainting in your sleep?

“…Unfortunately an appropriately timed serum prolactin level cannot differentiate seizure from syncope and occasionally, seizures cause sinus bradycardia, thus imitating vasovagal or cardiac syncope [20]. Vertebrobasilar migraine can also cause syncopal symptoms, (with headache and vomiting) though not usually at night [19]. Sleep paralysis and hypnogogic hallucinations occur in sleep-deprived individuals and narcoleptics, most of whom will have other characteristic features in the history (e. g., daytime somnolence) and abnormal polysomnography [1].…”