Basilar migraine is a dangerous form of the disease! Complication – stroke! Don't endure the pain...

Basilar migraine is one of the most serious neurological diseases. This form of the disease received its name due to the existence of the basilar artery, which supplies the posterior lobes of the brain, pons and cerebellum. During an attack, the patient experiences symptoms characteristic of damage to the cerebral structures supplied by this artery. These same symptoms form a migraine aura, and the main manifestation remains throbbing pain in the back of the head and spreading to one side of the head.

The epidemiology of the disease is varied. This form of migraine affects both children and adults. To a greater extent, she “prefers” women because of their anatomical and physiological characteristics. This form of pathology most often leads to the development of complications.

Causes

The exact mechanism of development of the disease is not known. Therefore, the etiology of the disorder is controversial; doctors do not give a clear answer about its origin. Based on some theoretical generalizations, we can give an approximate list of provoking factors.

• Excessive emotional and mental stress

There is also a physical aspect. As a result of overload, a large amount of stress hormones are released. Such as cortisol, norepinephrine, adrenaline and others. They trigger a biochemical chain reaction. The end point of this reaction is severe vascular stenosis. In which area the most pronounced spasm will occur depends on the inclination of the body and its characteristics. When the arteries supplying the occipital lobe of the brain are damaged, an attack of basilar migraine is observed. As normal hormone levels are restored, spontaneous regression of the episode is observed.

• Abuse of caffeine, nicotine, alcoholic drinks, energy drinks

Here and now. Basilar migraine is a consequence of the influence of psychoactive substances on the central nervous system. Much depends on the current hormonal levels, the state of the central nervous system, and other factors. If a person drinks alcohol, drinks coffee constantly or systematically smokes, this does not mean that at some point a basilar migraine will not develop. "Seniority" doesn't matter.

• Burdened heredity

According to studies, when there was one ancestor in the ascending line who suffered from the pathology in question, the probability of its manifestation in the phenotype is about 45%. Two - over 60%. This is not a death sentence; with proper preventive measures, it is possible to minimize risks. It all depends on the patient.

• Lack of sleep

Affects the patient's hormonal background. Disruption of circadian rhythms leads to insufficient production of melatonin and the release of large amounts of cortisol, which is normally synthesized in minimal quantities in the evening. This leads to an inadequate reaction: an increase in vascular tone is observed, the central nervous system becomes excited. The patient feels an extraordinary surge of vigor. A dual point: the release of hormones and disruption of the nervous system and leads to spasm of the arteries localized in the neck. The result is an attack of basilar migraine.

The same applies to disruption of the usual daily routine. Especially in the evening.

• The use of certain medications is a significant factor

A large group of medications have the ability to spasm arteries. Anti-inflammatory drugs of non-steroidal origin with systematic, long-term use or individual reaction of the body, some psychotropic drugs, also oral contraceptives, which are often abused by young women. It makes sense to review the therapeutic course and consult with your doctor again if the prescribed therapy has caused neurological disorders. Or refuse self-medication in another case.

• Hormonal peak states

Puberty, which has already been mentioned. And besides it - pregnancy, the initial phase of the menstrual cycle, menopause (andropause in men or menopause in women).

In addition to the above reasons, a large group of pathological factors can be distinguished. These are mainly disorders of the musculoskeletal system. The following diseases can provoke basilar migraine:

• osteochondrosis of the cervical spine;
• instability of the spinal column after injury, as a result of congenital or acquired anomalies of the muscular corset;
• fractures, bruises of the spine (regardless of how long ago), including after treatment and at the end of rehabilitation;
• hernia of the cervical spine (provoke compression of the arteries, and then a reflex spasm of blood vessels).

A large role is also played by atherosclerosis, a type of cholesterol deposition on the walls of the arteries. The high-risk group includes children with low birth weight. Congenital anomalies of connective tissue development, pathologies of the autoimmune profile, and systemic chromosomal abnormalities affect them. The exact pathogenesis of the disease has not yet been established. But the correlation with the above reasons is obvious and confirmed by multiple empirical data.

Danger, consequences and complications

Considering that this disorder is associated with cerebral circulation, in an advanced form it can provoke such serious disorders of the brain as stroke, heart attack and epilepsy . The risk of developing the latter in migraine sufferers increases 4 times!

During a headache attack, a complication may occur that results in a migraine stroke, after which blood circulation in the brain will be impaired for life.

Find out about other types of disease:

• vestibular and abdominal migraine;
• with and without aura;
• menstrual and chronic forms;
• cervical and ocular.

Symptoms of basilar migraine

The clinical picture of basilar migraine is severe, the symptoms are much more difficult to tolerate when compared with other types. In all cases, a pronounced aura is observed - phenomena preceding a painful attack. Among these are:

1. Hearing loss. Decreased hearing acuity on one side. In complex cases, there is a bilateral decrease in sound perception or complete deafness. Temporary, transitory phenomenon.
2. Visual impairment. Reduced visual acuity, double vision, and the formation of blind areas - scotomas, which look like black areas or spots. Also flashes of photopsia in the form of dots, spots, lines, rings, simple geometric shapes. The result of irritation of the occipital region of the brain. The simplest visual hallucinations. Transient blindness is possible with basilar migraine. Complete loss of vision for the duration of the aura with restoration of function upon completion.
3. Dizziness. Accompanied by the inability to navigate in space. The result of damage to the inner ear and the extrapyramidal system represented by the cerebellum. As a rule, the patient takes a forced lying position in order to somehow reduce the intensity of the symptoms.
4. Tinnitus, ringing.
5. Syncope, fainting. Occurs less frequently than other manifestations. During the stage, auras can be repeated several times. The symptom is alarming, because it indicates a pronounced drop in the quality of brain nutrition. Increases the likelihood of having a stroke.
6. Articulation disorders. A person is unable to speak normally due to damage to the speech motor center.

The mentioned symptoms do not always exist in combination. As a diagnostic criterion, doctors talk about the presence of at least two, so that a diagnosis of “basilar migraine” can be made. These deviations usually exist for a short period of time. In typical cases, the aura accompanies the patient for 5-10 minutes, then the phenomena are reduced and disappear on their own.

Basilar type migraine may be accompanied by a prolonged aura, when neurological signs change and appear alternately within an hour. Cases of the existence of an aura for more than 5 hours have been described, which is extremely rare, but possible.

After the end of the aura, the period of the attack itself begins. It is accompanied by an intense or extremely intense headache. Discomfort is localized in the back of the head, on one side. The nature of the unpleasant sensation is squeezing, in time with the beat of the heart, or bursting. The pain is not always located precisely in the back of the head; cases of diffuse discomfort or its localization in the parietal region have been described.

The neurological condition is paroxysmal and stable. Attacks develop several times a month or even a week, which indicates an aggressive course. Diagnosis and treatment are required. When exposed to provoking factors, the frequency of episodes may become higher. Removing the main culprit also affects the likelihood of an episode developing, but in the opposite way. Even the patient himself can influence the disorder.

What form of disease is this?

This is a chronic hereditary disease that manifests itself in intense, “aching” headaches localized in the occipital and temporal regions.
The disease has this name because it concerns pathological processes in the basilar artery, from which blood flows to all other parts of the body.

The attack begins suddenly.

Unlike other types of headaches that are triggered by bright lights, loud noises, etc., this type of migraine occurs without triggers.

Immediately before an attack, a person experiences an aura state - deterioration of auditory sensitivity and vision, ataxia, dizziness.

Important! The most severe consequences of an attack without timely treatment can be ischemic stroke and migraine infarction.

Diagnosis of the disease

Diagnosis of basilar migraine is carried out by neurologists. The neurologist prescribes a group of standard studies and, if necessary, gives directions for additional procedures to clarify the point of interest.

1. Oral questioning of the patient. To evaluate complaints, create an accurate clinical picture. Based on the symptomatic complex, we can talk about one or another condition. Make hypotheses and rule them out as the diagnosis continues.
2. Anamnesis collection. Allows you to get an idea of ​​the likely origin of the deviation. Be sure to clarify such points as lifestyle, habits, daily routine, diet, family history of diseases, past and current diseases, especially neurological, cardiovascular, endocrine. A number of other factors.
3. Testing basic reflexes.

All three of these activities are routine. They are carried out directly at the consultation appointment. But they set the vector for further diagnostics:

1. As a first measure, an ultrasound scan, duplex scanning of the vessels of the neck and brain is performed. This is necessary to assess the quality of blood flow in cerebral structures. During the diagnosis, several functional tests are performed to check how the vessels react to the patient’s motor activity (turning the neck, bending and other simple actions).
2. Electroencephalography. To determine the functional activity of the brain.
3. MRI of the brain. As part of the differential diagnosis of basilar migraine and the initial stages of multiple sclerosis, focal symptoms in tumors of cerebral tissue, the course of infectious and inflammatory disorders. It is possible to administer intravenous contrast to increase diagnostic information. MRI of brain vessels is also performed to exclude aneurysms and malformations. Congenital anomalies in the development of the blood supply system to cerebral structures.
4. Angiography. If necessary for visualization of blood vessels. X-ray of the cervical spine. MRI of the spinal column as part of the diagnosis of hernias, injuries and other structural changes.

A general blood test and a biochemical analysis of venous blood with an expanded picture of lipid structures are required. Doctors are interested in the concentration of high and low density lipoproteins (good and bad cholesterol, respectively), and the atherogenic index.

Additional methods may also be prescribed: vestibulometry, electrocochleography, and others.

The purpose of the examination includes distinguishing between several conditions similar to basilar migraine. Typical features that may be considered in the differential diagnosis include the following:

• basilar migraine is more severe;
• there is a pronounced aura;
• there is a clear sequence: an aura, only then an attack;
• there is photophobia and fear of sound;
• there is no tension in the neck muscles and no discomfort when touching the skin of the neck;
• There is a pronounced paroxysmal course, which does not happen with most other disorders.

Symptoms of basilar migraine and features of the course of the pathology should be assessed, among other things.

Treatment

Drugs that relieve the acute condition and facilitate treatment are prescribed based on the characteristics of the patient.
The well-known Analgin or other painkillers for treatment have a weak effect , since the basilar type has its own specifics.

The doctor prescribes drugs that reduce heart rate, relieve vasospasm, normalize pressure in the arteries, thereby reducing the speed of blood flow in the basilar artery.

They cope with these tasks perfectly:

1. Glucocorticosteroid drugs such as Dexamethasone and Prednisone;
2. Vascular and decongestants;
3. Anticonvulsants: Topomax, Neurontin;
4. Beta-blockers: Anaprillin, Atenolol.

Important! A minimum of 3.5-4 hours should pass between doses of several medications.

In order to relieve an acute condition, Prednisolone should be taken immediately after the onset of the aura condition and 4 hours after taking the first tablet. For the first hours, you need to stay as far away from bright sources of light and sounds as possible . The patient must be provided with supine rest and rest.

It is very important to stabilize the patient between attacks. These periods of "rest" can last from several weeks to several months. To balance the nervous system, sedatives are prescribed. Grandaxin and Amitriptyline work great.

Useful video on the topic:

Therapy

Prednisolone, one of the drugs used in the treatment of basilar migraine, is a first aid treatment.
Treatment of basilar migraine is carried out on an outpatient basis, excluding critical situations bordering on a stroke. In the acute criminal period, a short-term inhalation administration of a mixture of oxygen and carbon dioxide is carried out. This is not feasible at home. However, the procedure allows you to stop an attack in a matter of minutes. Glucocorticoids have the same positive effect.

Prednisolone is used actively for basilar migraine as a first aid remedy. If you use it in the initial phase, as soon as the aura has developed, there is a chance of stopping the attack.

A big role is given to mastering relaxation techniques. The trigger for a repeated episode of the disease is stress and nervous tension. Avoiding stress in life is almost impossible. Therefore, it is recommended to master relaxation techniques. If necessary, it is recommended to consult a psychotherapist (not to be confused with a psychiatrist or psychologist). In difficult cases, sedatives are prescribed as an aid. But pharmacological influence is ineffective outside of personal work, changing habits, emotional reactions, and therefore is considered as an auxiliary method.

In addition, physical therapy aimed at strengthening the muscles of the collar area, massage, and physiotherapy are indicated.

Treatment of basilar migraine with surgery is extremely rare. For example, to eliminate cholesterol plaques blocking an artery, especially against the background of hypoplasia (underdevelopment) of the vessel. The issue is complex and is decided at the discretion of the doctor after dynamic observation.

Diagnostic approach

To make a correct diagnosis, the patient must undergo a comprehensive examination, since the symptoms of this disease may also be present in the presence of impaired brain function or other diseases, for example:

• meningitis;
• stroke;
• increased intracranial pressure;
• arterial stenosis;
• Meniere's disease;
• brain tumors;
• cerebral aneurysm.

Diagnostics is carried out using such instrumental methods as:

• CT scan;
• electroencephalography;
• Magnetic resonance imaging;
• spinal puncture;
• angiography.

Prevention

To reduce the likelihood of developing basilar migraine or the risk of relapse, it is enough to follow a number of rules:

1. Quitting smoking, drinking alcohol, and uncontrolled use of medications.
2. Regular visits to at least a therapist as part of preventive examinations.
3. Normalization of physical activity regime. You can’t overwork, but sitting in one place is also contraindicated. Walking, cycling and swimming are suitable. Gentle physical activity, feasible for a person.
4. Creating an adequate sleep and wakefulness regime.
5. Minimizing the amount of animal fat in the diet. If possible, nutrition does not play a key role.
6. Avoiding stress, mastering relaxation techniques.

You can familiarize yourself with other types of migraines by reading our articles:

• Cervical migraine
• Ocular migraine

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About proper nutrition

Very often, you can avoid further stress, and therefore pain crises of basilar migraine, by following a proper diet.

This doesn't mean you should only eat oatmeal, coleslaw, and water.

You just need to limit the use of products containing tyramine. First of all, these include:

• chocolate and chocolate candies;
• cocoa;
• red and sparkling wines;
• cheeses and milk;
• tomatoes:
• nuts, etc.