Episodic vertigo in basilar artery migraine

Area of Science:

• Neurology
• Neuro-otology

Background:

• Migraine headaches are frequently accompanied by vestibular symptoms, primarily episodic vertigo.
• Auditory symptoms are also associated with migraine but occur less frequently.

Observation:

• Basilar artery migraine, described by Bickerstaff, involves symptoms attributed to basilar artery ischemia.
• Neuro-otologic and other transient brainstem dysfunction symptoms can manifest before, during, or between migraine headaches.
• Eleven detailed case histories of patients with basilar artery migraine are presented, including adolescents and adults with and without prior migraine diagnoses.

Findings:

• All patients met migraine diagnostic criteria and experienced vertigo preceding or during episodic headaches, sometimes with transient brainstem dysfunction.
• Some patients were misdiagnosed with peripheral vestibular end-organ disorders, undergoing unnecessary surgeries.
• The study highlights varied presentations of migraine with vestibular symptoms.

Implications:

• Accurate diagnosis of basilar artery migraine is essential to differentiate it from peripheral labyrinthine disease.
• Appropriate antimigraine therapy can be initiated, avoiding unnecessary surgical interventions for presumed end-organ disorders.