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Ask the Experts: What is basilar migraine, and what treatments are available?

Friedman, Deborah I. M.D., M.P.H.

doi: 10.1097/01.NNN.0000399237.23349.ef
Departments: Your Questions Answered

Deborah I. Friedman, M.D., M.P.H., Fellow of the American Academy of Neurology, is a professor of ophthalmology and neurology at the University of Rochester School of Medicine.

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Q I was just diagnosed with basilar migraine after having first been misdiagnosed with multiple sclerosis. What is basilar migraine, and what treatments are available?




A Basilar-type migraine (BTM) was first described in young women, but it can affect men and women of all ages. This rare form of migraine is characterized by aura symptoms arising from parts of the brain supplied by the basilar artery, which is one of the major arteries delivering oxygen to the brain. These symptoms can include spinning dizziness, imbalance, double vision, loss of vision in both eyes, numbness, trouble speaking, tinnitus (ringing in the ears), trouble with hearing and coordination in the arms, and, in more severe cases, loss of consciousness.

If the spells occur frequently, preventive treatment is recommended. A class of drugs called calcium channel blockers can reduce symptoms by stabilizing the walls of blood vessels to prevent spasms. Other medications typically used for migraine prevention, such as antidepressants or anti-convulsants, may be used. Beta blockers, another class of preventive migraine medication, are less commonly prescribed for BTM because they may worsen the condition in some cases.

For less frequent episodes, symptomatic treatment is effective. Pain and anti-inflammatory medications appear to be safe and effective in migraine symptom management. The migraine-specific medications triptans and ergotamines, however, have traditionally been avoided for BTM because they may constrict the basilar artery and possibly lead to stroke

It's helpful for people with migraine to examine triggers in their diet and lifestyle. Monitoring stress levels and changes in one's environment can be useful in identifying triggers, as is keeping a food journal. Certain aged foods such as cheese and cured meats, as well as alcohol, artificial sweeteners, and (I'm sorry to say) chocolate have been shown to trigger migraine, so it might be best to avoid them.

©2011 American Academy of Neurology