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Basilar Migraine

Basilar-Artery Migraine


Presentation

  • Literatures of migraineurs presented with coma were reviewed. The two patients are partially resolved with prophylactic propranolol or valproate therapy. BTM should be considered for any patient presenting with migraine and coma.[ncbi.nlm.nih.gov]
  • The signs and symptoms of neurological disease are elusive by their very nature, presenting a confounding diagnostic challenge.[books.google.com]
Fatigue
  • Intense emotional stimuli (74%) and sleep disorders (65%) were the most common trigger factors, followed by change in weather, sunshine, cold wind, acute stress, alcohol, and fatigue.[ncbi.nlm.nih.gov]
  • A 2014 study published in the journal Pain Medicine identified these as the ones most involved: Intense emotional situations Sleep disorders Weather Sunlight Cold wind Stress Alcohol Fatigue Diagnosis There are no specific tests for diagnosing migraine[verywell.com]
  • The acute phase may be accompanied by nausea, vomiting, chills, polyuria, sweating, facial edema, irritability, and extreme fatigue.[medical-dictionary.thefreedictionary.com]
  • Discover 6 possible causes for fatigue headache weight gain including Hypothyroidism PMS (Premenstrual Syndrome) and Cushing Syndrome.[emergingindustries.eu]
  • "It can be very fatiguing," Dr. Messina says.[health.com]
Falling
  • These children continue to "fall through the cracks" of our medical education system.[books.google.com]
  • I’m a chronic migraineur headaches and migraines are nothing new to me but last summer to autumn (fall) I started getting sharp pain in my head in one of two coin-sized regions Nearly everyone will suffer an occasional headache it’s almost inevitable.[emergingindustries.eu]
  • I changed into a completely different person and not a nice one and my hair began falling out. I was so zoned and really couldn't function. One time, I turned the faucet on in the kitchen to rinse a few dishes and left it running...for hours.[healthboards.com]
  • I feel like I am being gently pushed over and often end up falling against walls.[tapatalk.com]
  • The cause of, or trigger to, menstrual migraine is thought to be the fall of the level of oestrogen that occurs at this time in the cycle. Oestrogen is one of the chemicals (hormones) that control the menstrual cycle.[patient.info]
Nausea
  • Although the typical symptoms like headache, nausea, weight loss, flushing, heart palpitation or paroxysmal hypertension during micturition are well established, we present an unusual case of bladder paraganglioma, 'misdiagnosed' with basilar-type migraine[ncbi.nlm.nih.gov]
  • The headache that follows these effects may be severe and there is nausea and sometimes vomiting and great intolerance to light.[medical-dictionary.thefreedictionary.com]
  • Treatments for MBA generally aim to relieve symptoms of pain and nausea. You might take pain relievers such as acetaminophen, ibuprofen, and naproxen, as well as nausea medicines such as chlorpromazine, metoclopramide, and prochlorperazine.[webmd.com]
  • Order Now no prescription necessary Published on: March 14, 2012 3:38 am Basilar-Type Migraine (BTM) headaches are not your average migraine headache- while many migraines with aura cause symptoms like dizziness, visual distortions, and nausea that can[migravent.com]
  • Antiemetics (anti-nausea): Medications to treat nausea, such as phenothiazine, may be used to treat migraine with brainstem aura.[verywell.com]
Muscle Tenderness
  • Individuals with tension headache typically complain of a band like sensation around the head; there may also be facial or neck muscle tenderness and/or nuchal rigidity. The absence of these clinical findings argue against this diagnosis.[prognosisapp.com]
Diplopia
  • The basilar-type aura had a median duration of 60 minutes and comprised vertigo 61%, dysarthria 53%, tinnitus 45%, diplopia 45%, bilateral visual symptoms 40%, bilateral paresthesias 24%, decreased level of consciousness 21%, hypacusia 21%, and ataxia[ncbi.nlm.nih.gov]
  • The symptoms can last from 5 to 60 minutes and may include ataxia, vertigo, diplopia, bitemporal or binasal visual field loss, dysarthria, tinnitus, hyperacusia, bilateral sensory changes and alterations in consciousness, but no motor weakness in peripheral[link.springer.com]
  • Features of the aura may include: vertigo dysarthria ataxia diplopia bilateral visual impairment or sensory symptoms The proceeding headache is usually occipital.[gpnotebook.co.uk]
Scotoma
  • […] phenomenon, e.g., scintillating scotomas. migraine, n See headache, migraine.[medical-dictionary.thefreedictionary.com]
  • Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, castles (teichopsia), wavy images or hallucinations.[healthcommunities.com]
  • […] whirled round with dizziness, and the ears ring as from the sound of rivers rolling along with a great noise, or like the wind when it roars among the sails, or like the clang of pipes or reeds, or like the rattling of a carriage, we call the affection scotoma[medlink.com]
  • During this stage, about one-third of patients see flashing lights, wavy lines and blank spots in their field of vision (called scotoma) for a few minutes to a few hours before the pain stage begins.[migrelief.com]
  • It can be combined with a scotoma (an area of vision that appears to be obstructed, or missing). The visual image fades as the headache begins.[physio-pedia.com]
Tinnitus
  • The basilar-type aura had a median duration of 60 minutes and comprised vertigo 61%, dysarthria 53%, tinnitus 45%, diplopia 45%, bilateral visual symptoms 40%, bilateral paresthesias 24%, decreased level of consciousness 21%, hypacusia 21%, and ataxia[ncbi.nlm.nih.gov]
  • Tinnitus E. Decreased hearing F. Double vision G. Ataxia H. Bilateral paresthesias I. Bilateral paresis J.[dynamicchiropractic.com]
  • The symptoms can last from 5 to 60 minutes and may include ataxia, vertigo, diplopia, bitemporal or binasal visual field loss, dysarthria, tinnitus, hyperacusia, bilateral sensory changes and alterations in consciousness, but no motor weakness in peripheral[link.springer.com]
  • Symptoms include partial or total loss of vision or double vision, dizziness and loss of balance (vertigo), poor muscle coordination, slurred speech, a ringing in the ears (tinnitus), and fainting.[medium.com]
Hearing Problem
  • Vertigo – 73% Lack of muscle coordination – 40-50% Nausea – 30-50% Problems with vision – 30-45% Confusion – 20% Weakness – 20% Hearing problems – 10-15% Causes of Basilar-type Migraine The causes of basilar migraines are yet to be fully understood, however[migrainemagazine.com]
  • Aura most commonly consists of a spinning sensation (vertigo), noise in the ears (tinnitus), double vision (diplopia), hearing problems (hypacusia), poor limb coordination (ataxia), and unpleasant sensations in the face arms or legs (ranging from prickling[migrainerelief.com]
  • problems The head pain experienced with basilar type migraine occurs at the base of the head.[whentaniatalks.com]
  • The symptoms will include two or more of the following : visual disturbances in both eyes speaking difficulties hearing problems tingling in the hands and feet dizziness vertigo ringing in the ears.[migrainetrust.org]
  • Hearing problems. Difficulty speaking or swallowing. Important note : see a doctor urgently if you get sudden weakness (particularly if it occurs for the first time).[patient.info]
Hyperacusis
  • Other symptoms such as diplopia, visual symptoms, dysarthria, hyperacusis, ataxia, decreased level of consciousness, and bilateral (simultaneous) paresthesias and tinnitus may also be noted.[prognosisapp.com]
  • Sensory amplification is very common -- Hyperacusis is common in migraine, which may differentiate it from most ear disorders. Sensitivity to light (photophobia) is also commonly present.[dizziness-and-balance.com]
Sudden Hearing Loss
  • Virre and Baloh (1996) suggested that sudden hearing loss may also be caused by migraine. Hearing loss in migraine rarely progresses (Battista, 2004).[dizziness-and-balance.com]
Visual Hallucination
  • Symptoms may include scintillating scotomata, formed stereotyped visual hallucinations in a single visual field or bilaterally, micropsia, and tunnel vision. [80] Other auras include paroxysmal vertigo, hemisensory dysesthesias, and, rarely, auditory[emedicine.medscape.com]
Headache
  • All consecutive patients citing headache as their chief complaint were asked to complete a face-to-face interview by a qualified headache specialist using a detailed questionnaire for headache.[ncbi.nlm.nih.gov]
  • Headache. 30:142-144, 1990. Silberstein SD: Twenty questions about headaches in children and adolescents. Headache, 30:716-724, 1990. Brad McKechnie, DC, DACAN Pasadena, Texas[dynamicchiropractic.com]
  • Primary headaches are idiopathic headache disorders where the causes of headaches are not clear such The headaches develop gradually last longer and are more debilitating than the migraine with aura.[emergingindustries.eu]
Vertigo
  • CONCLUSION: The relationship between BtM, dMV, and pMV refers to a distribution of severity across the disease spectrum of migraine-related vertigo.[ncbi.nlm.nih.gov]
  • […] benign paroxysmal positional vertigo (in which patients experience brief episodes of vertigo, lasting from seconds to 1 minute, when they move their heads in a certain way).[books.google.com]
Dizziness
  • This book provides a multidisciplinary approach to vestibular migraine and related syndromes in which dizziness is the most predominant feature.[books.google.com]
  • Some basilar migraine sufferers experience dizziness or problems with muscle coordination after the migraine attack.[migraine.com]
  • At first glance, somebody suffering from a BTM aura may appear to be intoxicated, as slurred speech, dizziness, and walking difficulties are common symptoms.[migravent.com]
  • It is also common for sufferers to experience problems after the migraine attack such as difficulty coordinating muscles or dizziness.[migrainemagazine.com]
  • BACKGROUND: Basilar-type migraine (BM) is the most common migraine "variant," representing 3-19% of migraine in children.BMis characterized by attacks of dizziness, vertigo, visual disturbances, ataxia, and/or diplopia, followed by migraine headache.[ncbi.nlm.nih.gov]
Ataxia
  • Mutations in the CACNA1A gene on chromosome 19 have been associated with a variety of clinical disorders, including familial hemiplegic migraine type 1 and episodic ataxia type 2 (EA2).[ncbi.nlm.nih.gov]
  • Ataxia H. Bilateral paresthesias I. Bilateral paresis J.[dynamicchiropractic.com]
Confusion
  • Percentage of people with basilar migraines who have each migraine symptom Vertigo, 73 percent Ataxia, lack of muscle coordination or unsteadiness, 43-50 percent Nausea or vomiting , 30-50 percent Vision changes, 43 percent Double vision, 30 percent Confusion[migraine.com]
  • The symptoms can be confused with other serious conditions, for one thing, so your doctor may call for more tests than would be normal with migraine. Also, there’s concern that those with BTM may have a greatly increased chance of stroke.[headacheandmigrainenews.com]
  • Vertigo – 73% Lack of muscle coordination – 40-50% Nausea – 30-50% Problems with vision – 30-45% Confusion – 20% Weakness – 20% Hearing problems – 10-15% Causes of Basilar-type Migraine The causes of basilar migraines are yet to be fully understood, however[migrainemagazine.com]
  • Double vision Blurred vision Temporary blindness Aphasic aura (slurred speech) Difficulty controlling your tongue, jaw, or throat muscles Ataxia (loss of balance while walking) Paresthesias (numbness or “pins and needles” in the face, hands, or feet) Confusion[migravent.com]
  • However, the symptoms can confuse everyone including Emergency personnel. My first bad BTM threw the ER staff for a loop while they ran CAT scans of my brain and ordered up a lumbar puncture (spinal tap) of my spine.[atomiccity.blogspot.com]

Workup

  • As urologists linked the presence of a tumor (by CT) and symptoms connected with micturition, no cystoscopy and no transurethral resection of the bladder was performed prior to detailed diagnostic workup.[ncbi.nlm.nih.gov]
  • Gastroenterologic evaluation and workup typically yield unremarkable results. [48] Abdominal migraine symptoms are usually relieved with sleep. Antiemetics may help in aborting an acute attack.[emedicine.medscape.com]

Treatment

  • At that time, proven treatment options for BM are rather limited and lamotrigine has been tested in BM patients because it was a widely tested treatment for migraine with aura.[ncbi.nlm.nih.gov]
  • The first chapter stresses the etiology and pathophysiology of childhood stroke as the basis for evaluations and treatment.[books.google.com]
  • Ultimately, complementary therapies are generally less likely to produce harmful side effects, despite questions of effectiveness, so do consider a treatment plan that utilizes the best of both drug treatment and holistic techniques.[headacheexpert.co.uk]

Prognosis

  • Disability and Prognosis As with other forms of Migraine, BTM can be disabling.[healthcentral.com]
  • Disability and Prognosis As with other forms of migraine, migraine with brainstem aura can be disabling.[americanmigrainefoundation.org]
  • […] frequent, prolonged, or particularly debilitating, medications such as verapamil or topiramate may be prescribed as a preventative therapy. [2] Last updated: 2/19/2015 Due to the rarity of these migraines, there is limited data on the long-term outlook ( prognosis[rarediseases.info.nih.gov]

Etiology

  • The first chapter stresses the etiology and pathophysiology of childhood stroke as the basis for evaluations and treatment.[books.google.com]
  • Migraine with aura symptoms clearly originate from the brainstem and are not ischemic in etiology. Because involvement of the basilar artery is unlikely, the term migraine with brainstem aura is preferred.[medlink.com]
  • Additionally, gastroparesis, which occurs during migraine, has been implicated as an etiologic factor for cyclic vomiting and abdominal migraine. [51, 52, 53] A serum lactate level is helpful in these children to exclude mitochondrial disorders.[emedicine.medscape.com]

Epidemiology

  • There is no firm clinical, epidemiologic, or genetic evidence that BM is an independent disease entity different from MTA.[ncbi.nlm.nih.gov]
  • Hemiplegic and basilar-type migraine: Epidemiology, genetics, and mechanisms. Headache Currents, 3 (4), 73–81. doi:10.1111/j.1743-5013.2006.00036.x[repub.eur.nl]
  • Basilar-type migraine: Clinical, epidemiologic, and genetic features. Neurology 2006;66: 880-886. Klapper J, Mathew N, Nett R. Triptans in the treatment of basilar migraine and migraine with prolonged aura. Headache. 2001;41:981-984.[americanmigrainefoundation.org]
  • Comments: Epidemiological studies have shown that sporadic cases occur with approximately the same prevalence as familial cases. The attacks have the same clinical characteristics as those in 1.2.4 Familial hemiplegic migraine.[mdjunction.com]
  • Basilar-type Migraine: Clinical, epidemiologic, and genetic features. Neurology 2006;66: 880-886. Klapper J, Mathew N, Nett R. Triptans in the treatment of basilar Migraine and Migraine with prolonged aura. Headache. 2001;41:981-984.[healthcentral.com]
Sex distribution
Age distribution

Pathophysiology

  • Starting from the neurological point of view, the pathophysiology, classification, neurophysiology and therapy of migraine are discussed.[books.google.com]
  • Functional neuroimaging: enhanced understanding of migraine pathophysiology. Neurology. 2000. 55(9 Suppl 2):S36-45. [Medline]. Goadsby PJ. Migraine pathophysiology. Headache. 2005 Apr. 45 Suppl 1:S14-24. [Medline]. Lagman-Bartolome AM, Lay C.[emedicine.medscape.com]
  • Pathophysiology of migraine. Annu Rev Physiol. 2013; 75 :365–91. Cyberpub. du 26 novembre 2012. [ PubMed ] [ Google Scholar ] 3. Buse DC, Pearlman SH, Reed ML, Serrano D, Ng-Mak DS, Lipton RB.[ncbi.nlm.nih.gov]
  • Migraine aura pathophysiology: the role of blood vessels and microembolisation. Lancet Neurol 2010; 9: 309-317. 9.0 9.1 Ducros A, Tournier-Lasserve E, Bousser MG. The Genetics of Migraine.[physio-pedia.com]

Prevention

  • Adequate care should be taken to prevent migraine attacks.[ncbi.nlm.nih.gov]
  • Other preventive strategies include following specialized diets and using mind-body techniques such as deep relaxation, visualization, and biofeedback to help people put an end to their headaches.[books.google.com]
  • Lamictal (lamotramine): Like Topamax, this anticonvulsant calms abnormal excitement in the brain; it's used to prevent seizures and to help manage certain psychiatric conditions such as bipolar disorder.[verywell.com]

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