Migraine With Brainstem Aura - Causes, Diagnosis, and Treatment

Introduction:

Did you know? A migraine isn't just a bad headache! It can also be associated with something called an aura. Aura is nothing but a warning sign that usually comes before or during a migraine attack. These auras can be like seeing a flashing light, a tingling in the fingers, slurred speech, a head-spinning, or even losing balance. Did you know? Not everyone with a migraine gets an aura! Only 25 percent of people with migraines experience it. And out of those people, only 6.6 to 10 percent have a special kind of migraine with brainstem aura! That means it’s pretty rare!

So, migraine with brainstem aura (MBA) happens when the brainstem sends out mixed-up signals. But what is the brainstem? It’s a super-important part of your brain that connects your brain to your spinal cord! It helps control breathing, heartbeat, blood pressure, balance, coordination, reflexes, and consciousness. Since migraine with brainstem aura (MBA) is so rare, it can be hard to diagnose! Want to learn how they diagnose and manage it? Keep reading!

What Is Migraine With Brainstem Aura?

Migraine with brainstem aura is a rare type of migraine. The symptoms originate from the brainstem and include dizziness, double vision, slurred speech, and vertigo (spinning). However, there are no symptoms of motor weakness, which means there is no difficulty moving. These symptoms can happen before or along with the headache! Previously, people called it basilar migraine, but it is not preferred now because the basilar artery is not involved in causing it. Anyone can get this type of migraine. But guess what? Females are more likely to have it than males!

Symptoms of Migraine With Brainstem Aura

Here are some things that can happen before or along with the migraine.

• Vertigo, a sensation like you are spinning.

• Slurred speech (dysarthria). Not being able to speak clearly.

• Double vision, which is also called diplopia.

• Temporary loss of consciousness, also called syncope.

• Ringing in the ear, called tinnitus.

• Loss of balance, coordination, or muscle control, called ataxia.

• Flashing lights, zigzag lights, or seeing weird patterns in one or both eyes are called visual aura.

• Decreasing hearing.

• Tingling or numbness in arms or legs.

• Feeling confused.

• Feeling sensitive to light or sound.

These symptoms slowly show up before or along with a migraine headache. These symptoms can stay up to an hour each but eventually fade away!

Causes of Migraine With Brainstem Aura

The exact cause of migraine with brainstem aura is not known. However, it is thought to happen because of something called cortical spreading depression (CSD). CSD is like a wave of electricity moving through the brain. This wave temporarily messes up the blood flow and how the nerve works. When this CSD occurs in the brainstem or in the cerebral cortex (outer part of the brain), it can cause all those symptoms!

People who get this type of migraine often have family members who get it, too! And certain gene changes or mutations can make someone more likely to have it. One of the examples is familial hemiplegic migraine (FHM, a type of migraine that causes muscle weakness on one side of the body during or before the headache attack).

Additionally, when brain activity is dysfunctional, blood flow changes or brain chemical changes can occur.

Triggers of Migraine With Brainstem Aura

The triggers include:

• Stress.

• Sleeping less or sleeping too much.

• Certain foods like alcohol, coffee, cheese, foods containing nitrites like processed meats, or those containing monosodium glutamate (MSG).

• Loud noise, super bright lights, strong smells, or changes in the weather.

• Too much exercise.

• Changes in hormones can occur in females.

• Taking too many headache medicines.

• Medicines that are taken for controlling blood pressure and birth control medicines.

• Changes in atmospheric pressure.

• Motion sickness.

• Not drinking enough water.

How Is Migraine With Brainstem Aura Diagnosed?

Here is how the doctors diagnose it;

• Doctors will ask everything related to your symptoms, such as when it starts and what happens before the headache starts.

• A set of rules called the International Classification of Headache Disorders (ICHD-3) criteria helps confirm the diagnosis. The criteria include:

  1. The aura is present for at least less than an hour, followed by a headache.

  2. There should be at least two brainstem aura symptoms that go away completely, and no muscle weakness or eye problems should be present.

• Some other sicknesses can act like migraine with brainstem aura, like seizures! So, doctors may use big machines that take pictures of your brain, such as MRI (magnetic resonance imaging) or CT (computed tomography), to make sure it's a migraine.

Treatment of Migraine With Brainstem Aura

Let's have a look at how it can be treated:

• Over-the-counter pain relievers and anti-nausea medicines can be used to manage pain and reduce throwing up. In some cases, doctors may give strong pain relievers like Rimegepant or Ubrogepant, which are called CGRP antagonists.

• Some medications like triptans and ergotamines are not used because they can reduce the blood flow to the brain (cerebral ischemia).

• Taking care of yourself is also super important, in addition to medicine! Lifestyle modifications like sleeping well, staying away from things that cause headaches, and keeping stress low can help with headaches.

Living With Migraine With Brainstem Aura

Living with migraine with brainstem aura is a little different because it's a rare kind. If you have it, always watch out for new symptoms, if your headaches get worse, or if any medicine makes you feel weird. Try to find out what things make your headaches start (triggers). Take your medicine just like the doctor says, and live a healthy life. This way, you can feel much better!

Conclusion

Migraine with brainstem aura is a rare kind of migraine that can have different symptoms. Doctors need to check carefully to determine if someone has it, and it's important to start treatment early! Treatment usually means taking medicine, staying away from things that cause headaches, managing those triggers, and making healthy choices in daily life. Taking all these steps can help a person control migraines and thus lead a happy and good life!

Key Takeaway From iCliniq

Living with this complex migraine with a brainstem aura can be difficult because it’s a rare kind. Doctors have to be very careful when figuring it out because other things can look the same. That’s why getting the right diagnosis is super important! Starting treatment early and following the doctor’s advice can make things much better. So, learn as much as you can so it can benefit you or any of your loved ones.