Question:
A girl presented with recurrent occipital headache associated with ataxia and vertigo. Her mother also has similar complaints. The most probable diagnosis is?
A girl presented with recurrent occipital headache associated with ataxia and vertigo. Her mother also has similar complaints. The most probable diagnosis is?
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Occipital headache with brainstem signs and a family history equals a posterior-circulation migraine.
Updated On: Jun 24, 2026
- Vestibular neuronitis
- Basilar migraine
- Tension headache
- Cluster headache
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The Correct Option is B
Solution and Explanation
Step 1: Pick out the discriminating features. Occipital headache combined with brainstem symptoms such as vertigo and ataxia points to involvement of the posterior (vertebrobasilar) circulation territory.
Step 2: Add the family history. A similar history in the mother indicates a strong hereditary, migrainous tendency rather than an acquired vestibular insult.
Step 3: Match to basilar migraine. Basilar-type migraine (migraine with brainstem aura) classically causes occipital headache with aura symptoms arising from the brainstem, including vertigo, ataxia, dysarthria, tinnitus and visual disturbance, and is more common in young females with a family history.
Step 4: Exclude the others. Vestibular neuronitis gives acute isolated vertigo without recurrent headache or family clustering. Tension headache is a bilateral pressing pain without vertigo or ataxia. Cluster headache produces severe unilateral periorbital pain with autonomic features, not occipital pain with ataxia.
Step 5: Conclude. The picture fits basilar migraine.
Step 2: Add the family history. A similar history in the mother indicates a strong hereditary, migrainous tendency rather than an acquired vestibular insult.
Step 3: Match to basilar migraine. Basilar-type migraine (migraine with brainstem aura) classically causes occipital headache with aura symptoms arising from the brainstem, including vertigo, ataxia, dysarthria, tinnitus and visual disturbance, and is more common in young females with a family history.
Step 4: Exclude the others. Vestibular neuronitis gives acute isolated vertigo without recurrent headache or family clustering. Tension headache is a bilateral pressing pain without vertigo or ataxia. Cluster headache produces severe unilateral periorbital pain with autonomic features, not occipital pain with ataxia.
Step 5: Conclude. The picture fits basilar migraine.
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