1.2.2 Migraine with brainstem aura

Previously used terms:

Basilar artery migraine; basilar migraine; basilar-type migraine.

Description:

Migraine with aura symptoms clearly originating from the brainstem, but no motor weakness.

Diagnostic criteria:
  1. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below
  2. Aura with both of the following:
  3. at least two of the following fully reversible brainstem symptoms:
  4. a) dysarthria1
  5. b) vertigo2
  6. c) tinnitus
  7. d) hypacusis3
  8. e) diplopia4
  9. f) ataxia not attributable to sensory deficit
  10. g) decreased level of consciousness (GCS ≤13)5
  11. no motor6 or retinal symptoms.
Notes:
  1. Dysarthria should be distinguished from aphasia.
  2. Vertigo does not embrace and should be distinguished from dizziness.
  3. This criterion is not fulfilled by sensations of ear fullness.
  4. Diplopia does not embrace (or exclude) blurred vision.
  5. The Glasgow Coma Scale (GCS) score may have been assessed during admission; alternatively, deficits clearly described by the patient allow GCS estimation.
  6. When motor symptoms are present, code as 1.2.3 Hemiplegic migraine.
Comments:

Originally the terms basilar artery migraine or basilar migraine were used but, since involvement of the basilar artery is unlikely, the term migraine with brainstem aura is preferred.

There are typical aura symptoms in addition to the brainstem symptoms during most attacks. Many patients who have attacks with brainstem aura also report other attacks with typical aura and should be coded for both 1.2.1 Migraine with typical aura and 1.2.2 Migraine with brainstem aura.

Many of the symptoms listed under criterion B1 may occur with anxiety and hyperventilation, and are therefore subject to misinterpretation.