Spinal Care, Neurology, Spinal Medical Advice and Information.

Basilar Artery Migraine


Migraine and its variants are common entities in the pediatric population. Estimates of the incidence of childhood migraine vary from between 2- 5%, which indicates that it effects as many children as are affected by febrile convulsions. Some migrane variants are common in children during the first years of life (ophthalmoplegic migraine,and alternating hemiplegia of childhood), while others do not begin until later childhood and adolescence (hemiplegic migraine and acute confusional states). One of the less well recognized types of complicated migraine is basilar artery migraine. Bickerstaff (1961) first drew attention to this form of migraine and in 1975 Golden and French reported a series of children with basilar artery migraine.

Basilar artery migraine affects the basilar artery and its branches and is reflected by disturbances in the function of the brainstem, cerebellum, and occipital (visual) cortex. While some authors feel that basilar artery migraine is rare in childhood migraine states, one series of cases described by Lapkin and Golden included 23 cases of basilar artery migraine diagnosed by the authors during an 18 month period. In that series, which was a review of 30 cases, the mean age of onset was 7 years and a history of migraine was present in 86% of the families studied.

There are a number of signs and symptoms which are related to the brainstem, cerebellum, and occipital cortex ischemia. Patients have been noted to have paresthesia around the mouth, tinnitus, nausea, vomiting, vertigo, ataxia, deafness, drop attacks, third nerve palsy, unilateral or bilateral visual loss, and diplopia. The most frequent neurologic symptom in Lapkin and Golden series was vertigo. Half of the children had one or more visual symptoms with transient bilateral blindness occurring in 5 of the 30.

In a recent article by Appleton, et al, amaurosis fugax is described as occurring in 5 patients in their teenage years as a migraine variant. The duration of maximum visual loss was between 5 and 10 minutes in 4 of the patients and between 20 and 30 minutes in the fifth. A characteristic pattern of visual loss occurred in 4 patients, who described a "mosaic" or "jigsaw" pattern of isolated scotomata that enlarged slowly until they eventually coalesced, resulting in complete visual loss. This characteristic pattern of visual loss may relate to ischemia of the choroid. In one of the patients, constriction of the retinal vessels was observed as well.

The authors felt that that paroxysmal, transient and recurrent nature of the episode suggests that they may represent a form of migraine. In other series of patients with idiopathic amaurosis fugax, a high incidence of migraine has been been described. In patients with idiopathic amaurosis fugax, it is important to remember that the differential diagnosis includes atheromatous disease of the internal carotid arteries, cardiac disease, Raynaud's disease, temporal arteritis, polycythemia, multiple myeloma, sickle cell anemia, tumors of optic nerve or chiasm, tobacco and substance abuse, glaucoma, papilledema, eclampsia, and hysteria.