What is the definition of Migraine with Brainstem Aura?

Migraine with brainstem aura (MBA) is a type of migraine headache with aura that is associated with pain at the back of the head on both sides. An aura is a group of symptoms that generally serve as a warning sign that a bad headache is coming. Auras may consist of dizziness and vertigo, slurred speech, ataxia, tinnitus, visual changes, and/or loss of balance. Although MBA can occur in men and women of all ages, they are most common in adolescent girls. The exact underlying cause of MBA is poorly understood. Migraines are likely complex disorders that are influenced by multiple genes, in combination with lifestyle and environmental factors. In rare cases, susceptibility to MBA may be caused by a change (mutation) in the ATP1A2 gene or CACNA1A gene. Treatment during an episode may include nonsteroidal anti-inflammatory drugs (NSAIDs) and antiemetic medications to help ease the symptoms.

What are the alternative names for Migraine with Brainstem Aura?

  • Bickerstaff migraine
  • Basilar artery migraine
  • Brainstem migraine
  • Vertebrobasilar migraine
  • Basilar migraine
  • Basilar-type migraine
  • MBA

What are the causes for Migraine with Brainstem Aura?

The exact underlying cause of migraine with brainstem aura (MBA) is not well understood. MBA, like all types of migraines, are likely complex disorders that are influenced by multiple genes in combination with lifestyle and environmental factors. Scientists also suspect that nerve abnormalities and/or altered blood flow to certain parts of the brain (brainstem and occipital lobes, specifically) may play a role in the development of MBA.

Susceptibility to MBA may rarely be caused by a change (mutation) in the ATP1A2 gene or CACNA1A gene. In these cases, episodes may occur in more than one family member.

What are the symptoms for Migraine with Brainstem Aura?

Episodes of migraine with brainstem aura (MBA) usually begin with an aura, which is a group of symptoms that serve as a warning sign that a bad headache is coming. Signs and symptoms of an aura vary, but may include:
  • Dizziness and vertigo
  • Disorientation
  • Double vision and other visual changes
  • Tinnitus
  • Loss of balance
  • Confusion
  • Dysarthria
  • Fainting
  • Loss of consciousness
These symptoms can last any where from two minutes to over an hour. They are then followed by a throbbing headache which is often along the back of the head, and nausea.

What are the current treatments for Migraine with Brainstem Aura?

During an episode of migraine with brainstem aura (MBA), people are usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and antiemetic medications to help ease the symptoms. In some cases, a nerve block can be used to treat pain if other therapies are not working. In people with episodes that are frequent, prolonged, or particularly debilitating, medications such as verapamil or topiramate may be prescribed as a preventative therapy.

What is the outlook (prognosis) for Migraine with Brainstem Aura?

Due to the rarity of these migraines, there is limited data on the long-term outlook (prognosis) for affected people. Although the symptoms are often severe during episodes, they generally resolve on their own with no lasting complications. Some research suggests that the frequency of MBA decreases with age, although they may evolve into episodes of more typical forms of migraines in some affected people. Migraines with aura do carry a small risk of migrainous infarction (stroke in the setting of a migraine attack) and ischemic stroke.

How is Migraine with Brainstem Aura diagnosed?

A diagnosis of migraine with brainstem aura (MBA) is made based on the presence of characteristic signs and symptoms. Although there are no tests available to confirm the diagnosis, additional testing may be ordered to rule out other conditions that can cause similar symptoms. These tests may include:
  • Brain MRI
  • MR angiogram (MRA)
  • Electroencephalogram
  • 24-hour heart monitor
  • Specialized blood tests

Is Migraine with Brainstem Aura an inherited disorder?

In most cases, migraines with brainstem aura (MBA) are not inherited. However, in rare cases, susceptibility to MBA may be caused by a change (mutation) in the ATP1A2 gene or CACNA1A gene. In these cases, an increased risk for MBA is inherited in an autosomal dominant manner. This means that to be affected, a person only needs a mutation in one copy of the responsible gene in each cell. In some cases, an affected person inherits the mutation from an affected parent. Other cases may result from new (de novo) mutations in the gene. These cases occur in people with no history of the disorder in their family. A person with one of these mutations has a 50% chance with each pregnancy of passing along the altered gene to his or her child.
Clinical Trial
  • Status: Not yet recruiting
  • Phase: N/A
  • Intervention Type: Behavioral
  • Participants: 200
  • Start Date: February 2021
Mind Body Balance for Pediatric Migraine
Clinical Trial
  • Status: Recruiting
  • Phase: Phase 3
  • Intervention Type: Drug
  • Participants: 300
  • Start Date: September 14, 2020
An Open-Label, 12-Month Study to Evaluate the Safety and Tolerability of STS101 (Dihydroergotamine Nasal Powder) in the Acute Treatment of Migraine