Migraine with brainstem aura is a rare subtype of migraine with aura. Although this entity has been known for many years, its diagnosis and even its existence are still a matter of debate. Previous studies demonstrated that current diagnostic criteria for migraine with brainstem aura are too open and brainstem symptoms may originate within the cortex and not in the brainstem. The aims of the present study were to analyse whether aura from the brainstem exists, how prevalent such a core syndrome is, to analyse if current diagnostic criteria define such a core syndrome and, if necessary, to develop new diagnostic criteria that define only the core syndrome. We analysed all migraine with brainstem aura cases described in detail in the literature, clinical cases from the Danish Headache Center (DHC) and our large sample of telephone interviewed cases with migraine with aura. We selected the 20 most convincing cases from the literature and convincing cases from the DHC. Of 79 migraine with brainstem aura cases described in detail in the literature, 44 fulfilled the diagnostic criteria for migraine with brainstem aura of the International Classification of Headache Disorders, 3rd edition (ICHD-3). In the DHC after face-to-face interview, neurological examination and imaging, four migraine with brainstem aura of 293 cases with migraine with aura (1.37%) were found, corresponding to 0.04% of the general population. The 20 most convincing cases had symptoms that likely originated in the brainstem. Our telephone-interviewed cohort included 1781 subjects with a diagnosis of migraine with aura or probable migraine with aura. Of these, 228 fulfilled the diagnostic criteria for migraine with brainstem aura of the ICHD-3. Thus, using telephone interview diagnosis according to current diagnostic criteria results in too many cases of migraine with brainstem aura being diagnosed. Therefore, we developed stricter diagnostic criteria in an attempt to include only those rare cases that definitely have aura originating from the brainstem. Migraine with brainstem aura does exist, but it is very rare. Existing diagnostic criteria are too unspecific, but it was possible to develop tighter criteria that define a core syndrome probably caused by brainstem dysfunction.

中文翻译：

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脑干先兆偏头痛：定义核心综合征。

脑干先兆偏头痛是偏头痛先兆的罕见亚型。尽管这个实体已经被人们知道很多年了，但是它的诊断甚至存在仍然是一个有争议的问题。先前的研究表明，目前偏头痛伴脑干先兆的诊断标准过于开放，脑干症状可能起源于皮质而不是脑干。本研究的目的是分析是否存在来自脑干的先兆，这种核心综合症的流行程度，分析当前的诊断标准是否定义了这种核心综合症，并在必要时制定仅定义核心的新诊断标准。综合症。我们分析了所有在文献中详细描述的偏头痛和脑干先兆病例，来自丹麦头痛中心（DHC）的临床病例以及我们通过电话采访的大量带有先兆偏头痛的病例。我们从文献中选择了20个最有说服力的案例，并从DHC中选择了有说服力的案例。在文献中详细描述的79例具有脑干先兆的偏头痛病例中，有44例符合《国际头痛分类法》（第3版）（ICHD-3）的脑干先兆偏头痛的诊断标准。面对面访谈，神经系统检查和影像学检查后，在DHC中，发现293例偏头痛先兆的四个偏头痛伴脑干先兆（1.37％），占总人口的0.04％。最令人信服的20个病例的症状可能起源于脑干。我们的电话访问队列包括1781名被诊断为先兆偏头痛或可能为先兆偏头痛的受试者。其中，228例符合ICHD-3脑干先兆偏头痛的诊断标准。因此，根据当前的诊断标准使用电话采访诊断会导致过多的偏头痛病例被诊断为脑干先兆。因此，我们制定了更严格的诊断标准，以试图仅包括那些肯定具有源自脑干的先兆的罕见病例。确实存在具有脑干先兆的偏头痛，但这是非常罕见的。现有的诊断标准太不确定，但是有可能制定更严格的标准来定义可能由脑干功能障碍引起的核心综合症。228名符合ICHD-3脑干先兆偏头痛的诊断标准。因此，根据当前的诊断标准使用电话采访诊断会导致过多的偏头痛病例被诊断为脑干先兆。因此，我们制定了更严格的诊断标准，以试图仅包括那些肯定具有源自脑干的先兆的罕见病例。确实存在具有脑干先兆的偏头痛，但这是非常罕见的。现有的诊断标准太不确定，但是有可能制定更严格的标准来定义可能由脑干功能障碍引起的核心综合症。228名符合ICHD-3脑干先兆偏头痛的诊断标准。因此，根据当前的诊断标准使用电话采访诊断会导致过多的偏头痛病例被诊断为脑干先兆。因此，我们制定了更严格的诊断标准，以试图仅包括那些肯定具有源自脑干的先兆的罕见病例。确实存在具有脑干先兆的偏头痛，但这是非常罕见的。现有的诊断标准太不确定，但是有可能制定更严格的标准来定义可能由脑干功能障碍引起的核心综合症。我们制定了更严格的诊断标准，以尝试仅包括那些肯定具有源自脑干的先兆的罕见病例。确实存在具有脑干先兆的偏头痛，但这是非常罕见的。现有的诊断标准太不确定，但是有可能制定更严格的标准来定义可能由脑干功能障碍引起的核心综合症。我们制定了更严格的诊断标准，以尝试仅包括那些肯定具有源自脑干的先兆的罕见病例。确实存在具有脑干先兆的偏头痛，但这是非常罕见的。现有的诊断标准太不确定，但是有可能制定更严格的标准来定义可能由脑干功能障碍引起的核心综合症。