Basilar, Brainstem, Complex Auras?
The type of aura I have is currently in the process of being reclassified. Basilar-Type Migraine is going out of fashion, but no one is quite sure what to call it yet. A lot of terms have been through around regarding my auras Basilar, brainstem, complex, and my favorite: Dramatic.
Originally the aura symptoms I have were called Basilar Artery Migraine1. The basilar artery is a major blood vessel going through the brainstem. This was back when we thought migraines were caused by expansion and/or spasm of the blood vessels in the brain.
Due to this theory when triptans were released in the mid 1990s they were contraindicated in the treatment of Basilar Artery Migraine with the thought that there was an increased risk of stroke and death. Since then we have discovered that Basilar aura sufferers have no higher risk of stroke than those with any other type of aura2.
For right now Basilar Artery Migraine has been reclassified as Basilar-Type Migraine. Though this is a bad term as well, since once again it is referring to the blood vessel and recent science tells us that auras are a cortical spreading depression3, essentially a wave in electrical activity in the brain that changes brain function.
Also, the use of triptans is still contraindicated in Basilar migraine since we’re slow to change our FDA warnings. If a doctor doesn’t want to break the rules they cannot diagnose a patient with Basilar Migraine and hand them a prescription for triptans. Which is silly, since Basilar Migraine has no increased risks in regards to triptans.
Even if Basilar Migraine was reclassified as brainstem aura4 it would be a crappy and misleading diagnosis. The symptoms of this kind of aura do not just impact the brainstem, in fact there are a few potential symptoms for each part of the brain.
Symptoms of Basilar Migraine (From ACHE.net):
- impairments or clumsiness in the speaking of words due to diseases that affect the mouth, tongue, or throat muscles (dysarthria)
- feeling of spinning (vertigo)
- noise in the ears (tinnitus)
- impaired hearing (hypacusia)
- double vision (diplopia)
- typically spots or flashes simultaneously in both temporal and nasal fields of both eyes
- in-coordination of limbs or walking (ataxia)
- decreased level of consciousness (state of being alert)
- paresthesias (abnormal or unpleasant sensation often described as numbness or as a prickly, stinging, or burning feeling) at the same time on both sides of the face, arms or legs
If you look at a corresponding map of the brain most of these symptoms do not occur in the brainstem. My neurologist muses on how so many of my symptoms seem to stem from the parietal lobe: perceptual distortions, clumsiness, etc. Though I also can get aphasia and have poor short term memory which is the Temporal lobe. So brainstem aura is an equally misleading diagnosis.
This is why I am not diagnosed as Basilar-Type Migraine since it would mean no triptans for no good reason, and the only relevant about the diagnosis at this point is the grouping of symptoms. However, aura doesn’t fully acknowledge the strangeness of my auras so I tend to use the terms Basilar aura, brainstem aura, or complex aura.
References and Resources:
- Basilar-Type Migraine (ACHE.net)1
- Migraine with Brainstem Aura (Up to Date)4
- Spinning Out of Control the Black Box of Basilar Migraine (Neurology)2
- Theory Behind Migraine Emerges: Cortical Spreading Depression (Dana.org)3
- Migraine Not Caused By Blood Vessel Dilation (The Med Circle)5