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Migraine with brainstem aura: Why not a cortical origin?

Geneviève Demarquay1,2, Anne Ducros3,4, Alexandra Montavont1

  • 11 Department of Neurology, Hospices Civils de Lyon, Lyon, France.

Cephalalgia : an International Journal of Headache
|October 28, 2017
PubMed
Summary

Migraine with brainstem aura symptoms, like vertigo and dysarthria, may originate in the cerebral cortex, not the brainstem. This suggests reclassifying brainstem aura as a typical migraine aura.

Keywords:
Migraine with brainstem aurabasilarcortexfunctional mappingspreading depression

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Area of Science:

  • Neurology
  • Neuroscience
  • Medical Research

Background:

  • Migraine with brainstem aura involves symptoms such as dysarthria, vertigo, tinnitus, hypacusis, diplopia, ataxia, or decreased consciousness.
  • The traditional view often localizes these symptoms to the brainstem.

Purpose of the Study:

  • To review clinical and functional imaging data supporting a cerebral cortical origin for brainstem aura symptoms.
  • To propose a new classification for migraine with brainstem aura.

Main Methods:

  • Review of existing clinical observations.
  • Analysis of functional mapping studies.
  • Integration of data on cortical functions related to aura symptoms.

Main Results:

  • Vertigo linked to vestibular cortex dysfunction.
  • Tinnitus and hypacusis associated with auditory cortex.
  • Diplopia potentially related to parieto-occipital cortex.
  • Dysarthria connected to precentral gyrus dysfunction.
  • Ataxia linked to parietal lobe processing.
  • Altered consciousness associated with prefrontal and parietal cortices.

Conclusions:

  • All symptoms of brainstem aura can originate from cortical dysfunction.
  • Brainstem aura may have a cortical origin, aligning with cortical spreading depression theory.
  • Migraine with brainstem aura should be classified as a typical migraine aura.