MIGRAINE WITH BRAINSTEM AURA – A CASE REPORT
Keywords:
Migraine with brainstem aura (MBA), International Classification of Headache Disorders, 3rd edition (ICHD-3), brainstem dysfunctionAbstract
Migraine with brainstem aura (MBA) is a rare subtype of migraine with aura, characterized by reversible neurological symptoms originating from the brainstem and accompanied by migraine headache. Because of its complex clinical presentation, MBA may mimic other serious neurological conditions, leading to diagnostic uncertainty. We present a case of a 47-year-old woman with recurrent episodes of diplopia, dysarthria, walking instability, and occipital headache and left-sided head pain, in whom extensive diagnostic evaluation excluded structural, vascular, and epileptic causes. The clinical features fulfilled the International Classification of Headache Disorders, 3rd edition (ICHD-3) criteria for migraine with brainstem aura. This case highlights the importance of careful clinical assessment, appropriate use of diagnostic tools, and awareness of MBA among clinicians to ensure timely diagnosis and management.
References
Bickerstaff E. Basilar artery migraine. Lancet 1961; 277(7167): 15-17. https://doi.org/10.1016/S0140-6736(61)92184-5.
Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia 2018; 38(1): 1-211. doi: 10.1177/0333102417738202.
Chirchiglia D, Chirchiglia P, Marotta R. A singular association of migraine with brainstem aura and Alice in Wonderland syndrome. Childs Nerv Syst 2019; 35(8): 1435-1437. doi: 10.1007/s00381-019-04170-8.
Ying G, Fan W, Li N, Wang J, Li W, Tan G, et al. Clinical characteristics of basilar-type migraine in the neurological clinic of a university hospital. Pain Med 2014; 15(7): 1230-1235. doi: 10.1111/pme.12402.
Rossi F, Gonzalez E, Rossi E, Tsakadze N. Exploding head syndrome as aura of migraine with brainstem aura: a case report. J Orofac Pain Headache 2018; 32(2): e34-e36. doi: 10.11607/ofph.1950.
Chaudhry P, Friedman D. Hiccups as a migraine aura. Cephalalgia 2015; 35(9): 831-834. doi: 10.1177/0333102414560633.
Kondziella D, Bender A, Diserens K, van Erp W, Estraneo A, Formisano R, et al. European academy of neurology guideline on the diagnosis of coma and other disorders of consciousness. Eur J Neurol 2020; 27(5): 741–756. doi: 10.1111/ene.14151.
Shevel E. The extracranial vascular theory of migraine–a great story confirmed by the facts. Headache 2011; 51(3): 409-417. doi: 10.1111/j.1526-4610.2011.01844.x
Cavestro C, Ferrero M, Mandrino S, Di Tavi M, Rota E. Novelty in Inflammation and Immunomodulation in Migraine. Curr Pharm Des 2019; 25(27): 2919-2936. doi: 10.2174/1381612825666190709204107.
Cui Y, Kataoka Y, Watanabe Y. Role of cortical spreading depression in the pathophysiology of migraine. Neurosci Bull 2014; 30(5): 812-822. doi: 10.1007/s12264-014-1471-y
Demarquay G, Ducros A, Montavont A, Mauguiere F. Migraine with brainstem aura: why not a cortical origin? Cephalalgia. 2018; 38(10): 1687-1695. doi: 10.1177/0333102417738251.
Marsala S, Gioulis M. Basilar migraine mistaken for encephalitis. Neurolog Sci 2012; 33(1): 213-214. doi: 10.1007/s10072-011-0658-5.
Aguila MR, Rebbeck T, Leaver AM, Lagopoulos J, Brennan PC, Hübscher M, et al. The association between clinical characteristics of migraine and brain GABA levels: an Exploratory Study. J Pain 2016; 17(10): 1058-1067. doi: 10.1016/j.jpain.2016.06.008.
Meylakh N, Marciszewski K, Di Pietro F, Macefield V, Macey P, Henderson L. Altered regional cerebral blood flow and hypothalamic connectivity immediately prior to a migraine headache. Cephalalgia 2020; 40(5): 448-460. doi: 10.1177/0333102420911623.
Rasmussen AH, Kogelman LJA, Kristensen DM, Chalmer MA, Olesen J, Hansen TF. Functional gene networks reveal distinct mechanisms segregating in migraine families. Brain 2020; 143(10): 2945-2956. doi: 10.1093/brain/awaa242.
Beukers R, Roos Y. Pontine capillary telangiectasia as visualized on MR imaging causing a clinical picture resembling basilar-type migraine: a case report. J Neurol 2009; 256(10): 1775-1777. doi: 10.1007/s00415-009-5204-5.
Ganji S, Hellman S, Stagg S, Furlow J. Episodic coma due to acute basilar artery migraine: correlation of EEG and brainstem auditory evoked potential patterns. Clin EEG 1993; 24(1): 44-48. doi: 10.1177/155005949302400110.
Pavelek Z, Souček O, Krejsek J, Sobíšek L, Klímová B, Masopust J, et al. The role of the immune system and the biomarker CD3 + CD4 + CD45RA-CD62L- in the pathophysiology of migraine. Sci Rep 2020; 10(1): 12277. doi: 10.1038/s41598-020-69285-4.
Kheirollahi M, Kazemi M, Amini G, Khorvash F, Ahangari F, Kolahdouz M, et al. Expression of prostaglandin I2 (prostacyclin) receptor in blood of migraine patients: a potential biomarker. Adv Biomed Res 2015; 4(1): 121. doi: 10.4103/2277-9175.158030.
Akda GT, Uca AU. Cystatin C as a potential biomarker to evaluate migraine. Arq Neuropsiquiatr 2020; 78(6): 337-341. doi: 10.1590/0004-282X20200005.
Yuasa N, Nagata E, Fujii N, Ito M, Tsukamoto H, Takizawa S. Serum apolipoprotein E may be a novel biomarker of migraine. PLoS One 2018; 13(1): e0190620. doi: 10.1371/journal.pone.0190620.
Celikbilek A, Sabah S, Tanik N, Ak H, Atalay T, Yilmaz N. Is serum S100B protein an useful biomarker in migraine? Neurol Sci 2014; 35(8): 1197-1201. doi: 10.1007/s10072-014-1679-7.
Cernuda-Morollon E, Martinez-Camblor P, Alvarez R, Larrosa D, Ramon C, Pascual J. Increased VIP levels in peripheral blood outside migraine attacks as a potential biomarker of cranial parasympathetic activation in chronic migraine. Cephalalgia 2015; 35(4): 310-316. doi: 10.1177/0333102414535111.
Lee MJ, Lee SY, Cho S, Kang ES, Chung CS. Feasibility of serum CGRP measurement as a biomarker of chronic migraine: a critical reappraisal. J Headache Pain 2018; 19(1): 53. doi: 10.1186/s10194-018-0883-x.
Aydin H, Bucak IH, Geyik M. Vitamin B12 and folic acid levels in pediatric migraine patients. Acta Neurol Belg. 2021;121(6): 1741-1744. doi: 10.1007/s13760-020-01491-3.
Deleva Stoshevska T, Nikoloska S, Veljanovski D, Nikoloski M, Stoshevski B. Migraine and patent foramen ovale - case report. Acad Med J 2023; 3(2): 189-195. https://www.doi.org/10.53582/AMJ2332189ds.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Tatjana Deleva Stoshevska
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under CC BY 4.0 
