What is Basilar Migraine

by Mikai InternalMedicine

Basilar Migraine (Migraine with Brainstem Aura)

– A subtype of migraine with aura, characterized by symptoms originating from the brainstem and/or both hemispheres of the brain. –

**Key Features:** – Reversible neurological symptoms, typically lasting 5–60 minutes, followed by a throbbing headache. – Symptoms may include: – Vertigo (spinning sensation) – Dysarthria (difficulty speaking) – Tinnitus (ringing in the ears) – Hypacusis (reduced hearing) – Diplopia (double vision) – Ataxia (lack of coordination) – Dysphasia (difficulty understanding or expressing speech) –

**Rationale:** These symptoms reflect brainstem and cerebellar dysfunction. –

**Diagnosis:** – Based on clinical criteria (IHS classification) and exclusion of other causes (e.g., stroke, vestibular disorders). – Imaging (MRI) may be needed to rule out structural lesions. –

**Management:** – Acute treatment: Triptans (e.g., sumatriptan) or antiemetics (e.g., metoclopramide). – Preventive therapy: Beta-blockers (e.g., propranolol) or anticonvulsants (e.g., topiramate) if frequent attacks. – **Rationale:** Targets both the aura and headache phases. **Note:** If symptoms persist or worsen, urgent evaluation for stroke or other serious conditions is essential.

Any pontine structure or circulation related to migraine?

by Mikai with No Comment InternalMedicine

**Dorsolateral Pons**: The dorsolateral pons is implicated in migraine pathogenesis due to its role in the trigeminovascular network. Dysfunctional brainstem regulation here may lead to impaired regional blood flow and perimeningeal vasodilation, contributing to migraine symptoms. – *Rationale*: Harrison’s Principles of Internal Medicine (2025) and the Oxford Handbook of Neurology highlight the brainstem’s role in cranial autonomic dysfunction, which is secondary to the headache cascade. – **Circulation**: While no specific pontine circulation is uniquely tied to migraine, the posterior circulation (e.g., basilar artery) supplies the pons and may be indirectly involved in brainstem dysfunction. However, primary vascular changes are not causative but secondary to trigeminovascular activation. – *Rationale*: Vascular changes in migraine are secondary, as per Harrison’s, and not the primary driver of the headache cascade.

Context:  [HarrisonPrincipleofInternalMedicine2025] studies indicate that vascular changes in migraine and cluster headache, when present, are similarly driven by these cranial auto - nomic systems. Thus, they are secondary, and not causative, events in the headache cascade. Moreover, they can often be mistaken for symptoms or signs of cranial sinus ...

[pdfcoffee.com_oxford-handbook-neurology-pdf-free] produced by dysfunctional brainstem regulation of craniovascular afferents.  In a genetically predisposed individual, activation of the trigeminovascular  network in the dorsal midbrain and dorsolateral pons presumably causes:  (a) impaired regional blood fl ow to the brain, (b) perimengeal vasodilat...

[HarrisonPrincipleofInternalMedicine2025] peripheral or central nervous system (CNS) are damaged or activated inappropriately. Headache may originate from either or both mechanisms. Relatively few cranial structures are pain-producing; these include the scalp, meningeal arteries, dural sinuses, falx cerebri, and proximal segments of the lar...
Source Document:  HarrisonPrincipleofInternalMedicine2025
pdfcoffee.com_oxford-handbook-neurology-pdf-free