Abstract Details

Title Spinning out of Control: The Black Box of Basilar Migraine

Topic Headache

Presentation(s) P01 - (-)

Poster/Presentation
Number 084

Objective

Background Basilar migraine, also known as basilar-type migraine and basilar artery migraine, is a migraine sub-type that involves symptoms thought to originate from the brainstem and/or from bilateral simultaneous hemisphere activation. The diagnosis can only be made if there are two attacks that involve two of the following fully reversible symptoms: dysarthria, vertigo, tinnitus hyperausia, diplopia, visual symptoms simultaneously in both temporal and nasal fields of both eyes, ataxia, decreased level of consciousness, and/or simultaneously bilateral paraesthesias1. There is no evidence that posterior circulation oligemia or ischemia occurs as part of the pathophysiology of basilar migraine. Despite the lack of evidence for basilar artery vasoconstriction, patients with basilar migraine have been excluded from many triptan clinical trials.

Design/Methods We queried the Research Patient Data Registry from July 2010 to July 2011 for all patients seen at the John R. Graham Headache Center with a diagnosis of migraine with basilar migraine features who utilized a triptan. The terms utilized for the migraine with basilar migraine features search were migraine, basilar, dysarthria, vertigo, tinnitus, hyperacusia, diplopia, ataxia, altered consciousness, and/or loss of consciousness. The terms utilized for the triptan search were sumatriptan, rizatriptan, zolmitriptan, eletriptan, frovatriptan, and naratriptan.

Results The total number of patients identified was 29. The average age was 44, range (18-69). The most common triptan prescribed was sumatriptan (68%). Mild side effects to triptans occurred in only 10% of patients. Triptans were effective in 58% and 44% were exposed to more than one triptan.

Conclusions In this study, it appears that triptans were a safe, effective abortive treatment of migraine with basilar features. Based on these data, the FDA mandated triptan package insert contraindication in patients with basilar migraine features, should be reconsidered.

Authors/Disclosures
Paul G. Mathew, MD, DNBPAS, FAHS, FACSM, FAAN (Harvard Medical School/Mass General Brigham/Atrius Health) PRESENTER	Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abbvie/Allergan. Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lilly. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen. Dr. Mathew has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven/Pfizer. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Theranica. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Impel. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Upsher Smith. Dr. Mathew has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Linpharma. Dr. Mathew has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie.
Shivang Joshi, MD (Community Neuroscience Services)	Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Abbvie. Dr. Joshi has received personal compensation in the range of $0-$499 for serving as a Consultant for Nerivio. Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Axsome. Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Joshi has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Abbvie. Dr. Joshi has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for lundbeck. Dr. Joshi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for scilex. The institution of Dr. Joshi has received research support from Biohaven.
Huma Sheikh, MD (NY Neurology Medicine, PC)	Dr. Sheikh has nothing to disclose.
Thomas Neylan (University of California, San Francisco)	The institution of Thomas Neylan has received research support from National Institutes of Aging.

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