Hansen Jakob M, Goadsby Peter J, Charles Andrew C
Headache Research and Treatment Program, Department of Neurology, University of California Los Angeles, USA
Headache Group, Clinical Neurosciences and NIHR-Wellcome Trust Clinical Research Facility, King's College London, UK.
Cephalalgia. 2016 Mar;36(3):216-24. doi: 10.1177/0333102415584601. Epub 2015 May 5.
There is significant variability in the clinical presentation of migraine, both among patients, and between attacks in an individual patient. We examined clinical features of migraine with aura in a large group of patients enrolled in a clinical trial, and compared retrospective migraine attack characteristics reported upon enrollment in the trial with those recorded prospectively in the trial.
Patients with migraine (n = 267) with typical visual aura in more than 30% of their attacks were enrolled from 16 centers for a clinical trial. Upon enrollment, patients provided a detailed retrospective description of the clinical features of their attacks of migraine. During the trial, clinical symptoms in migraine attacks starting with aura were recorded prospectively in 861 attacks.
Retrospectively reported visual aura symptoms were variable and often overlapping; the most common symptoms were dots or flashing lights, wavy or jagged lines, blind spots, and tunnel vision. Multiple patients reported more than one visual phenomenon. Approximately half of the patients reported nonvisual aura symptoms, the most common were numbness and tingling, followed by difficulty in recalling or speaking words. A significant percentage of patients also reported a change in olfaction. There were several inconsistencies between the features of prospectively recorded and retrospectively reported attacks. Headache, nausea, photophobia, and phonophobia were all less common in prospectively recorded attacks as compared with retrospective reporting. Nausea was prospectively recorded in only 51% of attacks and mostly with mild intensity. The occurrence and severity of nausea was reduced with advancing patient age. Phonophobia was not consistently recorded in conjunction with photophobia.
These findings are consistent with variable involvement of different brain regions during a migraine attack. The variable occurrence of nausea, and phonophobia in conjunction with photophobia, both defining features of migraine, may be an important consideration in designing clinical studies of migraine in which prospectively recorded attacks are diagnosed based on these clinical features.
偏头痛的临床表现存在显著差异，无论是在患者之间，还是在个体患者的不同发作之间。我们在一项临床试验纳入的一大组患者中研究了伴先兆偏头痛的临床特征，并将试验入组时回顾性报告的偏头痛发作特征与试验中前瞻性记录的特征进行了比较。
从16个中心招募了偏头痛患者（n = 267），这些患者超过30%的发作有典型的视觉先兆，用于一项临床试验。入组时，患者对其偏头痛发作的临床特征进行了详细的回顾性描述。在试验期间，对861次以先兆开始的偏头痛发作的临床症状进行了前瞻性记录。
回顾性报告的视觉先兆症状各不相同且常常重叠；最常见的症状是点状或闪烁的灯光、波浪状或锯齿状线条、盲点和管状视野。多名患者报告了不止一种视觉现象。约一半的患者报告了非视觉先兆症状，最常见的是麻木和刺痛，其次是回忆或言语困难。相当比例的患者还报告了嗅觉变化。前瞻性记录和回顾性报告的发作特征之间存在一些不一致之处。与回顾性报告相比头痛、恶心、畏光和畏声在前瞻性记录的发作中都不太常见。前瞻性记录中只有51%的发作出现恶心，且大多为轻度。恶心的发生率和严重程度随患者年龄增长而降低。畏声与畏光并非始终同时记录。
这些发现与偏头痛发作期间不同脑区的不同程度受累一致。恶心以及畏声与畏光的不同发生率，这两者都是偏头痛的定义特征，可能是设计偏头痛临床研究时的一个重要考虑因素，在这些研究中前瞻性记录的发作是基于这些临床特征进行诊断的。
