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:
A. At least two attacks fulfilling criteria B-D
B. Aura consisting of visual, sensory and/or speech/language symptoms, each fully reversible, but no motor1 or retinal symptoms
C. At least two of the following brainstem symptoms:

    1. dysarthria
    2. vertigo
    3. tinnitus
    4. hypacusis
    5. diplopia
    6. ataxia
    7. decreased level of consciousness

D. At least two of the following four characteristics:

    1. at least one aura symptom spreads gradually over ≥5 min, and/or two or more symptoms occur in succession
    2. each individual aura symptom lasts 5-60 min2
    3. at least one aura symptom is unilateral3
    4. the aura is accompanied, or followed within 60 min, by headache

E. Not better accounted for by another ICHD-3 diagnosis, and transient ischaemic attack has been excluded.

Notes:
1. When motor symptoms are present, code as 1.2.3 Hemiplegic migraine.

2. When for example three symptoms occur during an aura, the acceptable maximal duration is 3×60 minutes.

3. Aphasia is always regarded as a unilateral symptom; dysarthria may or may not be.

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 C may occur with anxiety and hyperventilation, and therefore are subject to misinterpretation.