Teggi Roberto, Colombo Bruno, Bernasconi Luca, Bellini Chiara, Comi Giancarlo, Bussi Mario
San Raffaele Hospital-ENT, Milan, Italy.
Headache. 2009 Mar;49(3):435-44. doi: 10.1111/j.1526-4610.2009.01338.x. Epub 2009 Feb 11.
Association between migraine and vertigo has been widely studied during the last years. A central or peripheral vestibular damage may occur in patients with migrainous vertigo. Despite much evidence, at present the International Headache Society classification does not include a specific category for migrainous vertigo.
To assess the prevalence of central and peripheral vestibular disorders and postural abnormalities in patients diagnosed as affected by definite migrainous vertigo according to Neuhauser.
Thirty patients with migraine and acute vertigo lasting from minutes to hours underwent a full otoneurological screening for spontaneous, positional, and positioning nystagmus with head-shaking and head-thrust (Halmagyi) tests, an audiometric examination, and videonystagmography with bithermal stimulation according to Freyss. Videonystagmographic findings were compared with those of 15 migraineurs without lifetime vertigo (group M). Next day, a static posturography was performed; posturographic results have been compared with those of a second control group of 30 healthy patients matched for age and sex (group C).
In total, 14 subjects with migrainous vertigo showed otovestibular disorders; 6 subjects showed impaired vestibulo-oculomotor reflexes (20%). Five more patients had bilateral increased responses (16.6%). Five patients showed signs of central brainstem or cerebellar disorders for altered pursuit or saccades or positional direction changing nystagmus. Stabilometric results returned higher values of Length and Surface above all when testing was performed in eyes closed conditions compared with the normal control group. The subgroup of 14 subjects with migrainous vertigo and vestibular abnormalities performed poorly in stabilometric exams and seemed to rely more on visual cues in balance control than the subgroup of 16 subjects with migrainous vertigo but without abnormalities.
Our results indicate that vestibular functional damage may occur in all vestibular pathways; central and peripheral signs are equally represented. Our data are not inconsistent with the hypothesis that a vestibulo-spinal dysfunction is the causal factor for the posturographic results. Moreover, the Visual Romberg Index is significant for increased visual cue dependence in migraineurs.
偏头痛与眩晕之间的关联在过去几年中得到了广泛研究。偏头痛性眩晕患者可能发生中枢性或外周性前庭损害。尽管有很多证据，但目前国际头痛协会的分类中并未包括偏头痛性眩晕这一特定类别。
根据诺伊豪泽的标准，评估确诊为明确偏头痛性眩晕患者的中枢性和外周性前庭障碍及姿势异常的患病率。
30例偏头痛且急性眩晕持续数分钟至数小时的患者接受了全面的耳神经学筛查，包括自发性、位置性和定位性眼球震颤的摇头和头脉冲（哈尔马吉）试验、听力检查以及根据弗雷伊斯的方法进行的双温刺激视频眼震图检查。将视频眼震图检查结果与15例无终生眩晕的偏头痛患者（M组）的结果进行比较。第二天，进行静态姿势描记法检查；将姿势描记法结果与第二组30名年龄和性别匹配的健康对照患者（C组）的结果进行比较。
总共14例偏头痛性眩晕患者出现耳前庭障碍；6例患者出现前庭眼动反射受损（20%）。另外5例患者双侧反应增强（16.6%）。5例患者表现出中枢脑干或小脑障碍的体征，表现为跟踪或扫视改变或位置性方向改变性眼球震颤。与正常对照组相比，姿势稳定测量结果在闭眼条件下进行测试时，长度和面积值更高。14例有偏头痛性眩晕和前庭异常的患者亚组在姿势稳定测量检查中表现较差，并且在平衡控制中似乎比16例有偏头痛性眩晕但无异常的患者亚组更依赖视觉线索。
我们的结果表明，所有前庭通路都可能发生前庭功能损害；中枢性和外周性体征同样存在。我们的数据与前庭脊髓功能障碍是姿势描记法结果的因果因素这一假设并不矛盾。此外，视觉罗姆伯格指数对于偏头痛患者视觉线索依赖性增加具有重要意义。
