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Basilar migraine headache
Other Resources UpToDate PubMed

Basilar migraine headache

Contributors: Jamie Adams MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed


A migraine with brain stem aura, also known as a basilar migraine headache, is a type of migraine with aura symptoms that originate from the brain stem or bilateral cerebral hemispheres. Aura symptoms include diplopia, dysarthria, vertigo, tinnitus, bilateral visual disturbance, ataxia, bilateral paresthesias, or depressed consciousness. There must be 2 or more of these symptoms together or in succession lasting from 5-60 minutes each. There is no motor weakness. The migraine occurs during aura symptoms or follows within 60 minutes and often is characterized by a throbbing occipital headache with or without nausea. Symptoms completely resolve after the attack.

Age of onset is typically between 7 and 20 years old, and it is more common in women than in men. This type of headache may remit or transform into typical migraine with age.

Related topic: Migraine headache


G43.109 – Migraine with aura, not intractable, without status migrainosus

83351003 – Basilar migraine

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Transient ischemic attacks (TIA)
  • Cerebellar stroke
  • Cerebellar stroke
  • Brain stem stroke
  • Hemiplegic migraine
  • Idiopathic intracranial hypertension
  • Occipital neuralgia
  • Labyrinthitis
  • Meniere disease
  • Complex partial seizure
  • Episodic ataxia (Episodic ataxia type 1, Episodic ataxia type 2)
  • Multiple sclerosis
  • Acute demyelinating encephalomyelitis
  • Extrapontine myelinolysis
  • Meningitis (eg, Aseptic meningitis, Bacterial meningitis, Fungal meningitis)
  • Subarachnoid hemorrhage
  • Cerebral venous thrombosis (see Cerebral stroke)
  • Reversible posterior leukoencephalopathy syndrome
  • Brain stem or cerebellar tumor or metastasis
  • Arnold-Chiari malformation
  • Acute toxicity
  • CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy)
  • Somatic symptom and related disorders
  • Panic disorder

Best Tests

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Management Pearls

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Last Reviewed:03/21/2018
Last Updated:01/19/2022
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Basilar migraine headache
A medical illustration showing key findings of Basilar migraine headache : Ataxia, Diplopia, Dysarthria, Mental status alteration, Tinnitus, Vertigo, Vision loss, Paresthesias
Copyright © 2024 VisualDx®. All rights reserved.