Basilar migraine

Adam, I wondered if you knew if Basilar migraine is considered the same thing as MAV? I was diagnosed with Basilar Migraine from the Michigan Head Pain and Nuerological Institute in Ann Arbor last year. I credit these people with saving my life. However, I did not once hear any of them speak of MAV. Just wondering…
thanks! Gayla

Hi Gayla

That’s a tricky one. This is what John Waterston says about it in his MAV article.

“Despite the common association of vertigo with migraine, the International Headache Society criteria for migraine only recognise
adult onset migrainous vertigo in the setting of basilar migraine. Basilar migraine is probably the most dramatic
manifestation of vestibular migraine, with headache and vertigo being accompanied by symptoms of brainstem or occipital lobe
dysfunction. The term “vestibular migraine†has been proposed to describe migrainous vertigo that does not fulfil the criteria for
basilar migraine”

Most neurotologists tend to agree with this now. Another article somewhere says “Bickerstaff probably meant something
much more dramatic when he first described basilar migraine”.

What makes it difficult is that doctors want to use the International Headache Society criteria for diagnosing migraine and migraine-related
problems, but the classification is very small and doesn’t include many things that are known to be migrainous. It mostly focuses on headaches
and classifies people by headache symptoms rather than anything else. There are no universal criteria for diagnosing MAV yet - some have
been proposed but none have been widely accepted. Eventually, at a guess, I would say genetic testing will be the rule for diagnosing it - but
this could be 10 years away. This doesn’t necessarily mean that it is only a hereditary illness, it is very likely it is also sporadic, but they
may have a set of gene mutations they can look for.

That being said, Basilar migraine is very, very rare. 1 in 500 migraineurs are diagnosed with Basilar Migraine. When you consider that about
10% of the population have migraine, the rate of Basilar migraine is then something like 0.02%.

There has been a tendency for people to jump out and say “dont take triptans if you might have basilar migraine” but this has died
down a bit. It looks like Basilar migraine is becoming ‘just another manifestation of migraine among the many’… they are all treated the same - even
those with Hemiplegic migraine usually take drugs like Topamax.

I personally wouldn’t put too much faith in it unless there were clear signs of major neurological events during your migraines like
becoming unconscious. In the end, it wont affect treatment, but if you want to be cautious - avoid triptans (Imitrex etc.)