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Migraine with Brainstem Aura

Reviewed by: HU Medical Review Board | Last reviewed: October 2020

Migraine with brainstem aura is a subtype of migraine with aura. In this type of migraine, the aura symptoms come from nerves at the base of the brain (brainstem) or nerves on both sides of the brain (cerebral hemispheres). It affects all age groups and sexes, but it is more common in teenage girls.1-3

Other names for migraine with brainstem aura

Older names for migraine with brainstem aura that some people still use include:1,3

The ancient Greeks first described migraine with brainstem aura, but it was not formally named until 1961 by a Dr. Bickerstaff. People who have migraine with brainstem aura may also have other types of migraine attacks, such as migraine with typical aura.

Migraine with brainstem aura symptoms

The most common symptoms that people have during migraine with brainstem aura are:1-3

  • Dizziness or vertigo (feeling like the room is moving)
  • Slurred speech (also called dysarthria)
  • Ringing in the ears, trouble hearing, or double vision (also called diplopia)
  • Feeling unsteady or uncoordinated
  • Trouble concentrating or feeling confused
  • Fainting or loss of consciousness

In addition, many migraine with brainstem aura attacks will also have aura features that are found in migraine with typical aura, including:1-3

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  • Vision changes such as sparkles or zigzag lights, usually on 1 side of the vision
  • Numbness or tingling that travels up 1 side of the body
  • Trouble finding words or producing speech

Each symptom appears slowly over 5 minutes or so, and the symptoms may appear 1 after the other, sometimes on 1 side of the body and sometimes on both. Each can last for up to 1 hour and then goes away. Head pain follows aura symptoms within an hour and is felt at the base of the head on both sides.

Causes of migraine with brainstem aura

Doctors do not know exactly what causes most migraines with brainstem aura in most people. In some rare cases where the person has a relative with a history of migraines, there may be a mutation in the ATP1A2 or CACNA1A gene.3,4

More study is needed to better understand what causes migraine with brainstem aura. Small studies have found that most people with migraine with brainstem aura have a family history of some sort of migraine.4

As with all types of migraine, a person’s lifestyle and environment can trigger a migraine attack.

Diagnosing migraine with brainstem aura

Migraine with brainstem aura is diagnosed using the person’s description of their symptoms. This is why keeping a migraine diary can be so helpful in finding treatments and understanding your own triggers. Sometimes other tests may be ordered to rule out other health conditions. These tests include:

  • Brain MRI
  • MR angiogram or MRA (This test looks at the blood vessels going to the brain)
  • Electroencephalogram or EEG (This test looks for evidence of seizures)
  • 24-hour heart monitor
  • Specialized blood tests

Treatments for migraine with brainstem aura

The most common treatments for migraine with brainstem aura include:1

  • Pain killers, such as acetaminophen or ibuprofen, and anti-nausea drugs for acute treatments (after the migraine has started)
  • Preventive treatments such as topiramate, verapamil, and lamotrigine

Drugs that are commonly prescribed for other types of migraines are not recommended for people who have migraine with brainstem aura. These drugs include triptans, ergotamines, and beta-blockers.

Migraine with brainstem aura can be more difficult to live with than other types of migraine. This is because the aura symptoms can be more intense and last longer than migraine with typical aura.1