It Really is All in My Head: My Story of Basilar Migraines

By Wanda

My memories begin with migraines at a very young age which made it difficult to communicate to a family of non-migraine sufferers what was going on in my head.

Basilar migraines are associated with the occipital region of the brain, around the base of the skull. It’s hard to convince an adult your head hurts SO MUCH when you aren’t even in kindergarten.

By the time of my fourth birthday party, I’d already experienced my first brain trauma beginning my journey with the “Migraine Monster.”

Occipital_region-sagittal_view

(Above: Image depicting the occipital region of the brain, where basilar migraines originate. Via Patrick J. Lynch, Medical Illustrator, Wikimedia Commons)

The doctors may or may not have warned my parents of head pain, but surely everyone expected it to go away at some point. Sadly, the headaches lingered and migraines became a way of life.

The earliest type of migraine experienced by most children is the Basilar Migraine, which strikes 3-17% of children with migraines according to Migraine.com. Though the age given for onset is usually around 7, I can remember the symptoms much earlier.

Common symptoms in these attacks can include overwhelming dizziness, vertigo, lack of coordination, slurred speech, bodily tingling, confusion, difficulty hearing and double vision along with the migraine with aura. The pain of this migraine is usually located at the back of the head and to each side of the juncture of neck and skull.

Since I was labeled a klutzy child, the dizziness was blamed on allergies and the vision changes on needing glasses. If you are a parent, you will understand the episodes of trouble hearing and slurred speech were put down to being a child, as could be the case for most of these symptoms. Sometimes the doctor would treat me for a sinus infection, sometimes my mother would give me some acetaminophen, but usually I was told it was all in my head and sent to my room.

My parents and doctor did their best back in the early 1970’s, but no one had any idea what was going on in my head. Fortunately, migraine diagnosis and treatment have come a long way in 45 years.

According to the American Migraine Foundation, the name “Basilar Migraine” is misleading as these migraines do not, after all, involve short-term narrowing or spasm of the basilar artery.

Nerves, rather than vessels, cause Migraine with Brainstem Aura, just as they cause all migraines. Triptans and ergotamines, both common migraine medications that constrict blood vessels, do not work with Basilar Migraines because of their association with nerves. These migraines are usually more debilitating than typical Migraine with Aura because of the severity and duration of each episode, complicated by symptom management.

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The most popular preventative medications are topiramate, verapamil and lamotrigine, combined with an anti-inflammatory used at the onset of the migraine. Other over the counter medications can be used to treat the individual symptoms as well, such as nausea and vertigo. The easiest form of treatment, as with most migraines, is rest.

The underlying cause of Basilar Migraines is poorly understood and NIH classifies it as a “rare disease.” The truest way to diagnose Basilar Migraines is with brain imaging such as CAT scans, EEGs, and MRIs, just as with other types of migraine.

Basilar and Hemiplegic Migraines are often confused with one another, with the largest symptom difference being the weakness in one side of the body during a Hemiplegic Migraine. It is important that all Migraine with Aura symptoms, frequency, and duration are tracked to help develop a pattern and note new symptoms.

I use a migraine diary on my phone, which can then be emailed to my neurologist. Due to the rarity of these migraines, there isn’t much in the way of prognosis though in most cases they seem to occur less often with age and carry only risk of migrainous infarction (stroke in the setting of a migraine attack).


Sources:
The International Headache Society. https://www.ichd-3.org/1-migraine/1-2-migraine-with-aura/1-2-2-migraine-with-brainstem-aura/
Kirchmann M, Thomsen L, Olesen J. 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
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