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Migraine with brainstem aura (MBA) is a less common subtype of migraine with aura. It’s responsible for about 10 percent of cases of migraine with aura.
MBA used to be called basilar artery migraine or basilar-type migraine. Health experts used to believe that symptoms were triggered by a sudden narrowing or spasm of the basilar artery, which provides blood to the brainstem and many other important parts of the brain.
This article explores the current understanding of what causes migraine with brainstem aura and reviews common signs and available treatments.
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Although the exact cause of MBA is unknown, researchers believe it may involve a wave of altered brain activity that occurs in the brainstem or on the cerebral cortex (the brain’s surface).
Your brainstem is the lifeline of your brain — it’s the connection between your brain and the rest of your body. The brainstem contributes to a range of crucial functions. It regulates breathing, blood pressure, taste, eye movements, swallowing, and more.
Migraine can run in families, and genes may play a role. However, MBA isn’t usually caused by a single, specific gene.
Environmental factors can worsen MBA. Anxiety and hyperventilation (breathing very quickly) can worsen aura.
Common migraine triggers for MBA are similar to those for other types of migraine. They include:
Birth control (contraceptives) with estrogen may also raise the risk of stroke in people with migraine with brainstem aura. For those with other risk factors, like smoking or having high blood pressure, this risk may be even higher.
MBA can affect both children and adults. Symptoms include aura symptoms, along with symptoms linked to the brainstem.
Auras often include visual disturbances (visual auras) and signs such as:
These symptoms can resemble a stroke or seizure. If aura symptoms are new, severe, or different than usual, seek medical attention right away.
Less often, smelling strange odors or hearing certain noises (like ringing in the ears) are also part of an aura.
Additional MBA symptoms related to the brainstem’s functions may include:
Auras usually last no more than 60 minutes but sometimes can last longer. They’re caused by temporary waves of brain activity in certain parts of the brain in charge of processing vision, smell, sounds, or touch.
According to diagnostic criteria and guidelines from the International Headache Society, you must have certain features for a doctor to diagnose MBA. These criteria include:
Because many brainstem aura symptoms are also symptoms of conditions like stroke and epilepsy, other tests are usually needed to rule out other potential causes.
These tests may include MRI and CT scans of the brain or electroencephalograms (EEGs) to measure brain activity. Finding a correct diagnosis may involve seeing multiple doctors, including specialists, primary care doctors, and therapists.
Treatment for MBA is similar to treatment for other types of migraine. Your headache specialist can help you choose the best treatment, depending on your symptoms and other health conditions.
There are two types of medications used to treat migraine: medications you take during a migraine attack (acute medications) and preventive medications you take regularly to prevent or decrease future migraine episodes.
Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil) and naproxen (Aleve), which you can get over the counter. However, other options are available if NSAIDs aren’t safe for you.
Triptans, such as sumatriptan (Imitrex), are often used for other types of migraine. However, they are usually avoided in people with migraine with brainstem aura. Current drug labeling for sumatriptan says people with a history of basilar migraine should not use it. As stated earlier, basilar migraine is an older name related to migraine with brainstem aura.
This medication warning is based on older concerns that triptans may narrow blood vessels and could raise stroke risk in this type of migraine. More research is needed, so talk with your doctor about safer treatment options for your migraine attacks.
Some preventive therapies target a natural protein in the body, called calcitonin gene-related peptide (CGRP). Your doctor may prescribe CGRP-targeted therapies such as monoclonal antibodies and gepants.
Other preventive medications include topiramate (Topamax) and verapamil, which is a calcium channel blocker.
Sometimes, lifestyle changes can help as well. Migraine experts recommend:
Try keeping a headache diary of when you get migraine attacks and what might trigger them. Then you can try avoiding those potential migraine triggers to see if your symptoms improve.
MBA comes with the same elevated stroke risk seen in migraine with aura versus migraine without aura. While the symptoms might be frightening, the good news is that having migraine with brainstem aura doesn’t seem to be harmful in the long run.
If you have any type of migraine with aura, you can take extra steps to protect against stroke, including:
On MyMigraineTeam, people share their experiences with migraine, get advice, and find support from others who understand.
What are your MBA symptoms like? Let others know in the comments below.
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I get all the symptoms of brainstem auras. I take verapamil 3 times a day. I have tinnitus most days, my balance is bad and sometimes I know people are talking to me but I don't understand a word… read more
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