Introduction to Treatment of BAM
There are several methods available to treat BAM; however, some treatments prescribed
for common migraine (specifically vasoconstrictors like Imitrex) can be dangerous if used
by someone suffering from Basilar Artery Migraine.
Treatment and meds for BAM are very individual; you may have to try several things in
order to find what works for you. Most common treatments for BAM are tri-cyclic
antidepressants ("TCAs" for short, like amitriptylene and
nortriptylene--treatment for BAM has nothing to do with depression), beta-blockers (like
Inderal, brand name for propranolol, etc.), calcium channel blockers, and anti-convulsants
(like Depakote or Depakene, an anti-epileptic--again, it's effective for BAM in some cases
but doesn't mean that as a Bammer, you're also epileptic).
If you do have BAM, there are treatments available out there that do help, and don't
let any doctor tell you otherwise. To really find out what's going on and get an accurate
diagnosis (not an easy task, and most doctors don't know much about BAM), you should see a
good neurologist. Depending on what exactly your symptoms are, and depending on all
factors surrounding your case, you may or may not have BAM, or you may have "plain
old" TIAs (transient ischemic attacks, which also happen with BAM). Or, you may have
another disorder altogether.
As a patient, your diagnosis should only be made by a physician, preferably a
neurologist, who has seen you personally and who is familiar with your history and
symptoms, and who is able to perform a thorough neurological examination and manage a
program of any recommended neurological and medical testing.
You will see mention below of things such as "plain old aspirin." Remember,
however, not to take any medication--even an 81 mg aspirin daily--without consulting with
your physician/neurologist beforehand. To be wise, this consultation and discussion should
extend to the use of vitamin and mineral supplements, amino acid supplements,
"fitness supplements," weight loss medications, plant and herbal extracts in
supplement form, and the like. It would be advisable to also consult with him or her on
any significant changes you plan to make to your routine diet and/or exercise program.
More to come here...
Here are some of the treatments that are fairly common with BAM and can be successful
in attaining some semblance of "normalcy" by helping to prevent the attacks in
the first place (they are called "prophylactic treatments" because they are
preventing the condition rather than treating it in the acute state):
1. Beta Blockers. These work fine for some people, but if someone has *low blood
pressure* they can cause problems. If a patient has either normal or low blood pressure to
begin with, the use of Beta Blockers can lead to fainting, or other problems associated
with low blood pressure, especially when getting up quickly from a sitting or laying
position, etc.
2. Calcium Channel Blockers.
3. Tricyclic Antidepressants (TCAs). These include amitriptylene, nortriptylene, etc.
4. Anti-convulsants/anti-epileptics. The most commonly prescribed are Depakote and
other derivative forms of valproic acid. This is an effective prophylactic treatment for
both "regular" migraine and BAM, unlike the vasoconstrictors.
5. Aspirin Therapy. Another common thing is for a neurologist to prescribe aspirin. An
aspirin a day (usually prescribed as an 81 mg dose, which is approx. 1/4 of a regular
325mg aspirin--also called a "baby aspirin") can be a good idea. It is
prescribed for many BAM patients, stroke patients, heart patients, and those with TIAs.
Even if it doesn't do much to help, it probably won't hurt. It can help in stroke
prevention, and if you do indeed have BAM, that is definitely something to think about.
Aspirin helps to prevent what is called "platelet aggregation," which is the
sticking together of the platelets (they look like little plates, and I imagine that is
how they got their name) in your blood. The more platelet aggregation you have, the riper
the environment for a blood clot; this is the reason that aspirin is used as a
preventative treatment for those at risk for blood clots and stroke.
More to come here...
What Beta Blockers Do
Beta Blockers act by altering the transmission of nerve impulses from the brain to
certain parts of the body. They also affect conduction in the human heart, and thus
decrease heart rate and pulse. In addition, Beta Blockers lower blood pressure. It is not
known precisely how they do this; however, it is known that Beta Blockers do cause a
relaxation (and possibly dilation) of blood vessels. This is likely the mechanism by which
Beta Blockers lower blood pressure.
What Beta Blockers Treat
1. Hypertension (The most common condition treated by beta-blockers is hypertension, or
high blood pressure.)
2. Heart conditions (Beta-blockers are used to treat coronary angina and arrhythmias
(irregular heart beat). They are also used to prevent a recurrence of heart attack in
those patients who have already suffered a heart attack.)
3. Tremors (Beta-blockers are used to prevent certain kinds of tremor.)
4. Migraine (Certain Beta-blockers are used as a preventative treatment for migraine.
Beta-blockers, unlike some prophylactic migraine treatments, can also be used in the
preventative treatment of Basilar Artery Migraine.)
A List of Beta Blockers: Generic Name (Common Brand Names)
acebutolol (Acecor, Acetanol, Alol, Monitan, Neptal, Prent, Rhodiasectral, Sectra)
atenolol (Alinor, Altol, Antipressan, Atcardil, AteHexal, Atenil, Betablok, Betacard,
Felo-Bits, Myocord, Normiten, Oraday, Premorine, Prenolol, Seles, Tenolol, Tenormin,
Vericordin)
labetalol (Amipress, Ipolab, Labelol, Labrocol, Lamitol, Liondox, Normadate, Normodyne,
Presolol, Pressallolo, Trandate)
metoprolol (Beloc, Betaloc, Betalor, Bloxan, Cardiosel, Cardoxone, Denex, Lopresor,
Metolar, Metolol, Ritmolol, Selokeen, Seloken, Seloxen, Toprol, Toprol XI)
nadolol (Corgard, Nadic, Solgol)
pindolol (Bedrrenal, Betadren, Betapindol, Carpilol, Carvisken, Cinbloc, Cocaserin,
Decreten, Durapindol, Hexapindol, Marles, Osnon, Pidol, Pindesken, Pynastin, Symphol,
Viskeen, Visken)
propranolol (Acifol, Angilol, Apsolol, Arcablock, Artensol, Atensin, Beprane, Berkolol,
Betabloc, Biocard, Blocaryl, Cardinol, Caridolol, Cinlol, Ciplar, Corbeta, Deralin,
Detensol, Dibudinate, Dociton, Duranol, Elbrol, Emforal, Farprolol, Herzul, Impral,
Inderex, Inderal LA, Inderal, Indobloc, Indon, Kidoral, Lorol, Nelderal, Noloten,
Novopranol, Oposim, Procor, Prolol, Pronol, Propadex, Propalong, Propayerst, Prosin,
Pylapron, Rexigen, Sagittol, Sawatol, Scandrug, Sinai, Sudenol, Sumial, Tensiflex, Tesnol,
Sloprolol)
timolol (Aquanil, Betim, Blocadren, Cusimolol, Dispatim, Equiton, Glucolol, Nyolol,
Proflax, Temserin, Timacor)
betaxolol (Kerlone)
carteolol (Cartrol, Arteolol, Endak, Mikelan)
penbutolol (Levatol, Betapresin, Betapressin, Blocotin)
carvedilol (Coreg)
What Calcium Channel Blockers Do
Calcium Channel Blockers act by lowering blood pressure and decreasing the workload of
the heart. They act on both the blood vessels and the heart. Calcium Channel Blockers
change the way that calcium ions move into the cells of the blood vessels and heart. They
do this by altering what are called "calcium channels" in the membranes of the
cells. These channels are the "gates" through which the ions pass. Calcium ions
have an effect on the smooth muscle tissue, and hte contractability thereof, in the heart,
blood vessels, and other areas of the body.
What Calcium Channel Blockers Treat
1. Hypertension (The most common condition treated by Calcium Channel Blockers is
hypertension, or high blood pressure.)
2. Heart conditions (Certain types of Calcium Channel Blockers are used to treat
coronary angina and arrhythmias (irregular heart beat)). Bepridil is often used to treat
coronary angina, usually when the angina has not responded to treatment by other drugs.
Verapamil is used to treat arrhythmias. It is also prescribed as a preventative treatment
for BAM.
3. Prevention of brain damage (Nimodipine is sometimes used to prevent or minimize
brain damage after subarachnoid hemorrhage).
4. Migraine (Certain Calcium Channel Blockers are used as a preventative treatment for
migraine. Many Calcium Channel Blockers, unlike some prophylactic migraine treatments, can
also be used in the preventative treatment of Basilar Artery Migraine.)
A List of Calcium Channel Blockers: Generic Name (Common Brand Names)
amlodipine (Istin, Norvasc)
bepridil (Bepadin, Cordium, Cruor, Vascor)
diltiazem (Altiazem, Angiotrofin, Angizem, Britiazem, Calcicard, Calnurs, Cardizem CD,
Cardizem, Carex, Carizem SR, Clarute, Dilacor XR, Diladel, Dilatam, Dilgina, Diltam,
Diltikor, Diltime, Dilzem, Dilzene, Gadoserin, Helsibon, Herbessor, Lytelsen, Pazeadin,
Tilazem, Tildiem, Ziruvate)
felodipine (Hydac, Munobal, Plendil)
isradipine (DynaCirc, Lomir, Prescal, Vascal)
nicardipine (Antagonil, Cardene, Cardene SR, Cardepine, Dagan, Flusemide, Lincil,
Loxen, Nicardal, Nicodel, Nimicor, Perdipina, Perdipine, Ranvil, Ridene, Rycarden)
nifedipine (Adalat, Adalat CC, Alat, Alonix, Anpine, Aprical, Calcigard, Cardifen,
Cardiobren, Citilat, Coracten, Coral, Cordalat, Cordipin, Corinfar, Corotrend, Depin,
Dignokonstant, Duranifin, Ecodipin-E, Fedipin, Fenamon, Lemar, Megalat, Myogard, Nedipin,
Nifecard, Nifecor, Nifedepat, Nifedicor, Nifedine, Nifedipres, Nifelat, Nificard,
Nifidine, Noviken-N, Pidilat, Procardia, Procardia XL, Tibricol, Towerat, Vasdalat)
nimodipine (Admon, Nimotop)
verapamil (Akilen, Anpec, Azupamil, Berkatens, Calan, Calan SR, Cardiabeltin,
Cardiagutt, Caveril, Cordilox, Dignover, Dilacoran, Flamon, Geangin, Hormitol, Ikacor,
Ikapress, Inselon, Isoptin, Isoptin SR, Magotiron, Manidon, Praecicor, Rapam, Robatelan,
Securon, Vasolan, Vasopten, Verahexal, Veramex, Veramil, Verapin, Verdilac, Verelan,
Verpal, Verpamil)
What TCAs Do
(under construction)
What TCAs Treat
1. Depression
2. Migraine (Some TCAs are used as a preventative treatment for migraine. These TCAs,
unlike some prophylactic migraine treatments, can also be used in the preventative
treatment of Basilar Artery Migraine.)
A List of TCAs: Generic Name (Common Brand Names)
(list not yet completed)
generic (Brand)
What Anti-convulsants Do
Anti-convulsants act by ...
What Anti-convulsants Treat
1. Seizure disorders, most commonly epilepsy.
2. Migraine (Anti-convulsants are used as a preventative treatment for migraine.
Anti-convulsants approved for migraine prophylaxis, unlike some prophylactic migraine
treatments, can also be used in the preventative treatment of Basilar Artery Migraine.)
A List of Anti-convulsants: Generic Name (Common Brand Names)
generic (Brand)
Non-Traditional Treatments
More to come here...
Acute Versus Prophylactic Treatment Regimens for BAM
More to come here...
A list of treatments commonly used for treatment of migraine with aura and migraine
without aura are provided in the next sections.
To clarify, there are basically two types of treatment for any migraine, whether it is
Basilar Artery Migraine or not. One is "acute treatment," which is aimed at
alleviating the pain and symptoms of an acute attack, rather than preventing the attack or
migraine itself. The other type is "prophylactic treatment." The goal of
prophylactic treatment is "prophylaxis," or preventing the problem from
occuring. In the case of migraine treatment, prophylactic treatments are often the method
of choice for those patients with frequent and/or severe migraines.
Please keep in mind that treatments used for migraine with aura or migraine without
aura, or other forms and variants of migraine, are not necessarily either effective or
safe in the treatment of Basilar Artery Migraine.
Patients should be aware that self-medicating with any of these prescription drugs can
be dangerous. Never use anyone else's prescripton medication for an acute attack of
migraine, even if their symptoms seem the same as yours. Always follow the advice of a
good neurologist and take migraine medications only under a physician's care.
Acute treatment for migraine with aura, migraine without aura, and some other forms of
migraine includes several classes of medications, listed below. Though some of these
treatments are indeed similar or identical to treatments that are effectively prescribed
for treatment of Basilar Artery Migrane, some treatments (such as ergotamine-containing
substances and other vasoconstrictors like Imitrex) are potentially dangerous for treating
BAM.
Analgesics
- Fiorinal
- Codeine
- NSAIDs (Non-steroidal Anti-inflammatory Drugs)
Antiemetics
- Metaclopramide
- Prochlorperazine
Dihydroergotamine (DHE)
- Intravenous Dihydroergotamine (DHE)
- Cafergot (ergotamine and caffiene, in suppository form)
Prochlorperazine
Sumatriptan (Brand Name: Imitrex)
- NOTE: Manufacturer provides warning against prescribing Imitrex for basilar artery
migraine or hemiplegic migraine. Please see Why
Taking Vasoconstrictors Can Be Dangerous.
Corticosteroids
- Dexamethasone
- Methylprednisolone
Prophylactic migraine treatment is aimed at preventing, as opposed to treating an acute
case of, migraine. Prophylactic treatment for migraine with aura, migraine without aura,
and some other forms of migraine includes several classes of medications, listed below.
Though some of these treatments are indeed similar or identical to treatments that are
effectively prescribed for treatment of Basilar Artery Migrane, some treatments may not be
appropriate for treating BAM.
Beta Blockers
- Propranolol (a familiar brand name is Inderal)
- Nadolol
- Timolol
- Atenolol and metoprolol may also be effective
Calcium Channel Blockers
- Verapamil
- Diltiazem (used less often)
- Nifedipine (used less often for regular migraine--may be prescribed for Basilar Artery
Migraine) (a familiar brand is Procardia)
NSAIDs (Non-steroidal Anti-inflammatory Drugs)
- Naproxen
- Naproxen sodium
- Fenoprofen (Nalfon)
- Mefanamic acid (Ponstel)
- Methysergide (Sansert)(rarely used today)
TCAs (Tri-Cyclic Antidepressants)
MAOIs (MAO Inhibitors)
Cyproheptadine (Periactin)
Ace Inhibitors
Treatments for BAM and Regular Migraine Treatments
