Departments of Neurology and Algology, Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey.
Anesthesiology and Reanimation and Algology, Neuropsychiatry Center, Gazi University, Besevler, Ankara, Turkey.
Pain Med. 2018 Jan 1;19(1):178-183. doi: 10.1093/pm/pnx182.
Vestibular migraine (VM) is one of the most common underdiagnosed disorders. We aimed to study the clinical characteristics of VM patients who were referred to a neurology-headache unit by otolaryngology after exclusion of peripheral causes of vertigo.
One hundred and one patients diagnosed with VM in the headache unit were included. Description of vestibular symptoms, demographic and clinical features, trigger factors, accompanying diseases, and response to vestibular-suppressant medications and prophylactic migraine treatment were evaluated.
Vestibular symptoms were triggered by daily head and body movements and mainly consisted of brief attacks lasting seconds (60.4% of patients) although the total duration of the vestibular episode lasted hours or days. Other aggravating factors were moving visual stimuli, passive motion, and visually busy environments. Visually induced vestibular symptoms were defined by 71.3% of the patients, and positional motion-induced vestibular symptoms were described by 82.2% of the patients. Vestibular symptoms were mainly defined as feeling the ground slipping from under their feet (40.6%), feeling like there is an earthquake or swaying (27.7%), sensation of rocking on a boat (26.7%), and sensation as if stepping on empty space (24.8%). The majority of the patients (83.2%) previously used vestibular-suppressant drugs, and these drugs were effective temporarily only in 12.9%.
Chronic recurrent dizziness symptoms, rather than internal or external vertigo, are predominant in our VM patients. Recurrent brief dizziness attacks induced upon routine visual and/or postural motion, longstanding symptoms with limited response to vestibular suppressants, and precipitation by typical migraine triggers are suggestive of VM.
前庭性偏头痛（VM）是最常见的被漏诊的疾病之一。我们旨在研究在排除眩晕的外周原因后，由耳鼻喉科转至神经内科的 VM 患者的临床特征。
我们纳入了头痛科中诊断为 VM 的 101 名患者。评估了前庭症状、人口统计学和临床特征、触发因素、伴随疾病以及对前庭抑制剂和预防性偏头痛治疗的反应。
前庭症状由日常头部和身体运动触发，主要由持续数秒的短暂发作组成（60.4%的患者），尽管前庭发作的总持续时间为数小时或数天。其他加重因素为移动视觉刺激、被动运动和视觉繁忙的环境。71.3%的患者定义了视觉诱发的前庭症状，82.2%的患者描述了位置运动诱发的前庭症状。前庭症状主要表现为感觉脚下的地面在滑动（40.6%）、感觉像地震或摇晃（27.7%）、感觉像在船上摇晃（26.7%）和感觉好像踏空（24.8%）。大多数患者（83.2%）之前使用过前庭抑制剂，但这些药物仅在 12.9%的情况下有效。
我们的 VM 患者以慢性复发性头晕症状为主，而不是内部或外部眩晕。常规视觉和/或姿势运动引起的复发性短暂头晕发作、长期存在的症状、对前庭抑制剂的反应有限以及典型偏头痛触发因素的诱发，均提示为 VM。
