brainstem vascular malformations can be classified as arteriovenous malformations , venous malformations , cavernous malformations , or capillary telangiectasias . on pathological examination , capillary telangiectasias are a distinct type of vascular malformation , characterized by multiple thin - walled vascular channels , interposed between normal brain parenchyma . it has been postulated that telangiectasias are acquired lesions , caused by other underlying venous anomalies . , numerous case reports of presumed brainstem capillary telangiectasias have appeared ; usually pathological confirmation is absent . the fact that most capillary telangiectasias are found incidentally on mr imaging confirms the suggested clinically benign course in general , although a histopathologically proven , clinically aggressive case in an infant has been described . we performed a pubmed search of the literature and found 26 cases to date [ 58 ] . all but one of these cases were thought to be symptomatic , including symptoms of vertigo , tinnitus , hearing loss , ataxia , limb paresthesias , and monocular ptosis . basilar - type migraine , previously called basilar migraine or bickerstaff migraine , is a migraine variant first described by bickerstaff in 1961 . being a very rare migraine variant , the exact incidence and prevalence are unknown . although various criteria for the diagnosis have been applied over the years , fully reversible symptoms resulting from brainstem dysfunction are essential for the diagnosis . a recent study found the median age of onset to be 17  years and a female - to - male ratio of 3.8:1 . an 18-year - old woman presented to the outpatient clinic with a history of unilateral headaches , accompanied by phonophobia , but no photophobia , nausea , or vomiting . these headaches had increased in frequency over the last 6  months from once per year to about three times per week , typically lasted several hours , and were alleviated by sleep . the headache was frequently preceded by visual symptoms , such as flickering or black spots , in both visual fields . the patient had not used painkillers for these attacks , because in her opinion , these headaches were not severe enough to justify the use of medication . furthermore , this patient experienced a single episode of vertigo , followed by sudden loss of consciousness with a duration of about 10  min . no jerks , urinary incontinence , or tongue bite were present . on regaining consciousness , no confusional state was present , but patient noted the most terrible headache ever . several days later , an attack of vertigo without hearing loss occurred , with alternating paresthesias in all limbs , followed by the same terrible headache . for these a clinical diagnosis of basilar - type migraine was made , since the patient fulfilled the international headache society ( ichd - ii ) criteria . magnetic resonance imaging ( mri ) showed focal areas of hyperintensity in t2-weighted spin echo images , hypointensity in t2 * -weighted gradient echo images , and enhancement in postcontrast t1-weighted images ( fig .  1 ) . the diagnosis was revised to secondary headache attributed to cranial vascular disorder ( ichd - ii 6 ) , since one of the criteria for basilar - type migraine is that it can not be attributed to another disorder . she was treated with propranolol 80  mg per day as prophylactic treatment and acetaminophen 1,000  mg during attacks . during follow - up , she reported excellent response to the propranolol , with no new basilar - type migraine attacks for 12  months.fig . 1postcontrast axial and sagittal t1 , arrows pointing towards mr - suggested capillary telangiectasia postcontrast axial and sagittal t1 , arrows pointing towards mr - suggested capillary telangiectasia although no pathologic confirmation is available in our patient , we believe the radiological abnormality found on mri to be a capillary telangiectasia . this is supported by the absence of significant changes in a follow - up mri scan . the association with clinical symptoms remains unproven , although a clinical picture of  peculiar attacks of prolonged loss of consciousness  due to pontine telangiectasia has been described in the literature . another paper describes a case of basilar - type migraine associated with calcifications in the pontine tegmental nuclei . as this case illustrates , mr imaging of the brain should be considered if a rare cause of primary or secondary headache is suspected on clinical grounds . follow - up imaging seems only to be warranted in presumed symptomatic lesions , although the added value remains debatable , since no therapeutic interventions are available . regarding preventive treatment for basilar - type migraine , some experts prefer divalproex - sodium or verapamil instead of propranolol because of the concern of limitation of compensatory vasodilatory mechanisms . in our opinion no contraindication for propranolol exists in this patient because of the assumed causal relationship between the capillary telangiectasia and her clinical symptoms . with respect to acute treatment , there seems to be consensus against triptans because of concern over the potential for cerebral vasoconstriction and the uncertainty of the mechanism of basilar - type migraine , although evidence proving this causality is lacking . in conclusion , with this case report we provide some further evidence that pontine capillary telangiectasia might cause a clinical picture resembling basilar - type migraine .