Episodic vertigo in basilar artery migraine.

Vestibular symptoms commonly occur in migraine, and episodic vertigo is most frequently seen. Auditory symptoms also occur, but are less common. When Bickerstaff described basilar artery migraine in 1961, he postulated that the many different symptoms were caused by basilar artery ischemia. He documented that neuro-otologic and other symptoms could occur before or during a migraine headache; others later established that these symptoms could also occur during the headache-free period. Case histories of eleven patients with basilar artery migraine are presented in detail. All met the diagnostic criteria for migraine and experienced vertigo before or during episodic headaches--sometimes with other symptoms of transient brainstem dysfunction. Cases represented both typical and unusual manifestations of migraine with vestibular symptoms: four patients were adolescents, three were more than 45 years old and had previously diagnosed migraine headaches, and four were young adults not previously known to have migraine. Many of the patients were thought to have disorders of the vestibular end organ (sometimes in addition to migraine) and three had undergone previous endolymphatic sac decompressions or perilymph fistula repairs. Diagnostic criteria are reviewed, in order that patients with basilar artery migraine can be distinguished from those with peripheral labyrinthine disease, to allow initiation of appropriate antimigraine therapy and avoidance of unnecessary medical and surgical therapy for end-organ disorders.