Prof Peter Goadsby`s review article on Migraine was very stimulating
and informative. As the author points out, the diagnosis and the treatment
of migraine can be made difficult by the variability of presentation of
symptoms in individuals with headache.
In this comprehensive review of recent advances in the diagnosis and
management of migraine, it is curious that no mention was made about
Basilar migraine a variant of migraine, which frequently affects young
women and girls and bears a strong relationship with menstruation.(1)
Since it was described in 1961 by Bickerstaff as a rare variant,
basilar migraine has been shown to affect all age groups and both sexes
with the usual female predominance.(2)
The Headache Classification Committee of the International Headache
society has come out with the following diagnostic criteria for the
basilar migraine. (2)
1. The patient must have two attacks that have three of the following four
characteristics:
A. One or more reversible aura symptoms indicating cortical or brainstem
dysfunction that --
B. Develop gradually over more than four minutes
C. There is a limit to each aura of 60 minutes
D. A headache that must occur within 60 minutes of the end of the aura, if
it occurs at all.
2. The patient must demonstrate two or more aura symptoms of the following
types:
A. Visual symptoms in both the temporal and nasal fields or both eyes B.
Dysarthria C. Vertigo D. Tinnitus E. Decreased hearing F. Double vision G.
Ataxia H. Bilateral paresthesias I. Bilateral paresis J. Decreased levels
of consciousness.
And there is some evidence to suggest that triptans which are commonly
used in the management of classical migraine is contraindicated in Basilar
migraine. (3)
Rapid Response:
Basilar Migraine: Does it exist?
Basilar migraine: Does it exist?
Prof Peter Goadsby`s review article on Migraine was very stimulating
and informative. As the author points out, the diagnosis and the treatment
of migraine can be made difficult by the variability of presentation of
symptoms in individuals with headache.
In this comprehensive review of recent advances in the diagnosis and
management of migraine, it is curious that no mention was made about
Basilar migraine a variant of migraine, which frequently affects young
women and girls and bears a strong relationship with menstruation.(1)
Since it was described in 1961 by Bickerstaff as a rare variant,
basilar migraine has been shown to affect all age groups and both sexes
with the usual female predominance.(2)
The Headache Classification Committee of the International Headache
society has come out with the following diagnostic criteria for the
basilar migraine. (2)
1. The patient must have two attacks that have three of the following four
characteristics:
A. One or more reversible aura symptoms indicating cortical or brainstem
dysfunction that --
B. Develop gradually over more than four minutes
C. There is a limit to each aura of 60 minutes
D. A headache that must occur within 60 minutes of the end of the aura, if
it occurs at all.
2. The patient must demonstrate two or more aura symptoms of the following
types:
A. Visual symptoms in both the temporal and nasal fields or both eyes
B.
Dysarthria
C. Vertigo
D. Tinnitus
E. Decreased hearing
F. Double vision
G.
Ataxia
H. Bilateral paresthesias
I. Bilateral paresis
J. Decreased levels
of consciousness.
And there is some evidence to suggest that triptans which are commonly
used in the management of classical migraine is contraindicated in Basilar
migraine. (3)
References
1. Bickerstaff ER: Basilar artery migraine. Lancet, 1:15-17, January 7,
1961.
2. Tollison CD, Kunkel RS: Headache: Diagnosis and Management.
Williams and Wilkins, Baltimore, 1993.
3. Klapper J, Mathew W, Nett R: Triptans in the treatment of basilar
migraine and migraine with prolonged aura. Headache 2001 Nov-Dec 41(10):
981-984
Competing interests:
None declared
Competing interests: No competing interests