Migraine With Brainstem Aura

Migraine with brainstem aura is a rare subtype presenting with transient brainstem symptoms such as vertigo, dysarthria, tinnitus, diplopia, or ataxia. Pathophysiology involves cortical spreading depression affecting the brainstem and cerebellar networks. Diagnosis is clinical, with careful differentiation from cerebrovascular or demyelinating disease. Management includes acute migraine therapy and prophylaxis with calcium channel blockers or antiepileptics. Prognosis is similar to other migraine types but requires careful monitoring for neurologic complications.