Jung Jae Hoon, Yoo Myung Hoon, Song Chan Il, Lee Jae Ryung, Park Hong Ju
*Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul; and †Department of Otolaryngology, Jeju National University, Jeju, Republic of Korea.
Otol Neurotol. 2015 Feb;36(2):282-8. doi: 10.1097/MAO.0000000000000656.
We evaluated vestibular function test results in vestibular migraine (VM) patients, including caloric, vestibular evoked myogenic potential (VEMP), and dynamic posturography measurements and assessed their relationship with treatment responses.
Retrospective case series review.
Tertiary referral center.
We investigated a cohort of 80 VM patients who had suffered recurrent vertigo attacks for more than 6 months. A combination of lifestyle modifications and prophylactic medications were used to treat these subjects. The patients were asked to score the treatment success by ranking symptom score from 0% to 100% for the improvement in overall severity of headache and vertigo. Patients were then classified as complete remission, symptomatic improvement 50% or more, or less than 50% improvement after 6 months of treatment. The periods needed for symptomatic improvement in the 50% or more patient group were recorded, and the responsiveness to medications and the vestibular test result metrics were analyzed to identify clinical outcome predictors.
A symptomatic improvement of 50% or more in vertigo and headache was observed in 71% and 75% of the study subjects across mean periods of 2.3 and 2.2 months, respectively. Improvements in vertigo and headache did not coincide in all. Abnormal caloric, VEMP, and vestibular ratio measurements were found in 25%, 29%, and 58%, respectively. Abnormal vestibular ratios on posturography showed a significant correlation with a poor treatment response of vertigo, and a normal VEMP was significantly related to complete remission from headache, although abnormal caloric results showed no significant correlation with treatment responses. A poor response of vertigo symptoms was observed in 6% of patients with a normal vestibular ratio and 48% of patients with abnormal vestibular ratio. Complete remission from headache was observed in 61% of patients with a normal VEMP and 30% in patients with an abnormal VEMP.
More than 70% of the patients with VM experienced improvements in both headache and vertigo through a combination of lifestyle changes and prophylactic medications. Abnormal vestibular ratios on posturography and abnormal VEMP responses were frequent findings in VM patients with recurrent attacks for more than 6 months and were indicators of a poor prognosis. The pathophysiology of VM appears to be closely related to vestibular abnormalities, especially in vestibulospinal pathways. Further study with a large population is needed to establish the relationship exactly.
2b Individual retrospective cohort study.
我们评估了前庭性偏头痛（VM）患者的前庭功能测试结果，包括冷热试验、前庭诱发肌源性电位（VEMP）和动态姿势描记法测量，并评估了它们与治疗反应的关系。
回顾性病例系列研究。
三级转诊中心。
我们调查了一组80例VM患者，这些患者反复眩晕发作超过6个月。采用生活方式改变和预防性药物联合治疗这些患者。要求患者通过对头痛和眩晕总体严重程度改善的症状评分从0%到100%进行排名来评估治疗成功率。然后将患者分为完全缓解、症状改善50%或更多、或治疗6个月后改善不足50%。记录症状改善50%或更多患者组所需的时间，并分析对药物的反应性和前庭测试结果指标，以确定临床结局预测因素。
分别在平均2.3个月和2.2个月的时间里，71%和75%的研究对象眩晕和头痛症状改善50%或更多。眩晕和头痛的改善并非在所有患者中同时出现。冷热试验、VEMP和前庭比值测量异常的患者分别为25%、29%和58%。姿势描记法中异常的前庭比值与眩晕治疗反应差显著相关，VEMP正常与头痛完全缓解显著相关，尽管冷热试验结果异常与治疗反应无显著相关性。前庭比值正常的患者中6%眩晕症状反应差，前庭比值异常的患者中48%眩晕症状反应差。VEMP正常的患者中61%头痛完全缓解，VEMP异常的患者中30%头痛完全缓解。
超过70%的VM患者通过生活方式改变和预防性药物联合治疗，头痛和眩晕均有改善。姿势描记法中异常的前庭比值和异常的VEMP反应在反复发作超过6个月的VM患者中很常见，是预后不良的指标。VM的病理生理学似乎与前庭异常密切相关，尤其是在前庭脊髓通路中。需要进行更大规模人群的进一步研究来确切确定这种关系。
2b级个体回顾性队列研究。
