Re: Basilar Artery Migraine

Posted By CCF Neurology MD - AY on September 30, 1998 at 13:19:35:

In Reply to: Basilar Artery Migraine posted by Neil Ricardson on September 30, 1998 at 01:38:59:






Doctor, my wife has been diagnosed as suffering from a Basilar
Artery Migraine.  Her symptoms are slow gait, loss of dexterity in
limbs (sometimes down one side), slurred speech, tinitus and severe,
though not frequent, headache pain often lasting for days.  She has tried
calcium channel blockers (flunezerine), sandomigraine, tryptonol
(doubling as an antidepressent) and parnate (also an antidepressent).
While each of these take the edge off the symptoms, they have not
resolved the condition.  Our neurologist, and others we have seen,
say the migraine will go away eventually.  However, she has
had it now for 11 months and it is showing no signs of abating.  
Is it likely she will now have this condition for life?  What are the
chances that such a prolonged migraine will cause permanent damage (there
is, we understand, a chance of a stroke; how often does this happen to
chronic patients?).  Is there any new medication that might help?  Is
surgery an option (to dialate the artery as in angioplasty)?  
We have two small children and are getting desperate.  Any information
on the above or on other aspects of the condition would be appreciated.
Any publication, journal articles etc would also be helpful.
Thanks.
Neil



=


Thanks for your question.  The symptoms described in your message are
indeed those commonly associated with vertebro-basilar migraine (also called
Bickerstaff type migraine).  As with migraine headaches in other locations
in the brain, it is thought that the vessel walls (in this case the vertebral
and/or basilar arteries or their branches) have abnormal reactivity, and
prone to cycles of constriction and dilatation, hence causing the headache
and the neurological impairments.  Unfortunately, two classes of migraine
medications commonly used in other migraines - namely the ergotamines and
the triptans - cannot be used in basilar migraines due to the risk of
causing excessive vasoconstriction, and precipitate an infarct.
Because of the vascular nature of the generation of migraines, there is indeed
a higher risk for ischemic strokes in the same vascular territory, but
different clinical studies report different increases in risk.  It appears
that your wife is already being given the appropriate prophylactic/preventive
medications (calcim channel blockers, and anti-depressants).  The symptomatic
treatment for basilar migraines is more restricted, as mentioned above, and
usually moderate analgesics and possibly mild narcotics are options to be
considered.
It is difficult to predict the long term course of basilar migraine.  Surgery
or interventional angiography is not an option for treatment.
If you live in the Cleveland area, the Headache Center (Dept. Neurology)
at the Cleveland Clinic has a group of neurologists specialized in headaches
(Drs. Gretter, Kunkel, and Yuska-Mays).
If you would like to make an appointment at the Dept. of Neurolgy
please call 1-216-444-5559 or 1-800-CCF-CARE.
I hope this information is helpful.  Best of luck.
This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.