Department of Medicine, Neurologic Clinic, Headache Centre, University of Perugia, Perugia, Italy.
Department of Medicine, Otolaryngology and Head-Neck Surgery Clinic, University of Perugia, Perugia, Italy.
Acta Neurol Scand. 2018 Oct;138(4):270-277. doi: 10.1111/ane.12941. Epub 2018 Apr 16.
This observational study aimed to investigate the presence of potential vestibular system subclinical dysfunction among migraineurs without a history of vertigo and dizziness compared with healthy controls.
Patients diagnosed with episodic migraine with and without aura were enrolled. All patients and healthy controls underwent vestibular examination using the following conventional tests: sitting position, Pagnini-McClure's, Dix-Hallpike's, head hanging, video head impulse, subjective visual vertical, Romberg, Fukuda, and caloric vestibular stimulation by Fitzgerald-Hallpike's tests. Nystagmus and angular velocity of the slow phase during culmination phase was analyzed by video-nystagmography.
Overall, 33 patients (76% female, 7 with aura and 26 without aura; mean age (mean ± SD): 29.1 ± 4.3 years) and 22 controls (33% female, mean age: 30.8 ± 9.4 years) were enrolled. There were no statistically significant differences in demographic features between patients and controls. Caloric vestibular stimulation test results were found to differ among patients and controls. In particular, right and left angular velocity (AV) were highly correlated one another (r = 0.88, P < .001). Right AV (53.0 ± 6.7 vs 44.0 ± 9.6) and left AV (54.3 ± 5.3 vs 43.3 ± 9.0) were statistically higher in migraineurs as compared to controls (P < .001). Also right V-HIT (1.1 ± 0.1 vs 0.8 ± 0.4) and left V-HIT (1.1 ± 0.1 vs 0.7 ± 0.2) were statistically higher in migraineurs compared to controls (P < .001).
Our findings suggest a subclinical alteration of vestibular pathway in migraineurs who have never complained vertigo or postural imbalance. This finding supports the hypothesis of a vestibular-cerebellar dysfunction in migraineurs, particularly among those with aura.
本观察性研究旨在比较无眩晕和头晕病史的偏头痛患者与健康对照组之间是否存在潜在的前庭系统亚临床功能障碍。
纳入诊断为有或无先兆的发作性偏头痛患者。所有患者和健康对照者均接受以下常规检查：坐位、Pagnini-McClure 试验、Dix-Hallpike 试验、头悬位、视频头脉冲试验、主观垂直视觉、Romberg 试验、Fukuda 试验和由 Fitzgerald-Hallpike 试验进行的冷热水前庭刺激试验。视频眼震图分析终末相时的眼震和慢相角速度。
共纳入 33 例患者（76%为女性，7 例伴先兆，26 例无先兆；平均年龄（均值±标准差）：29.1±4.3 岁）和 22 例对照者（33%为女性，平均年龄：30.8±9.4 岁）。患者和对照者在人口统计学特征方面无统计学差异。患者和对照者的冷热水前庭刺激试验结果不同。特别是右、左角速度（AV）高度相关（r=0.88，P<.001）。与对照者相比，偏头痛患者的右 AV（53.0±6.7 比 44.0±9.6）和左 AV（54.3±5.3 比 43.3±9.0）均显著升高（P<.001）。与对照者相比，偏头痛患者的右 V-HIT（1.1±0.1 比 0.8±0.4）和左 V-HIT（1.1±0.1 比 0.7±0.2）也显著升高（P<.001）。
本研究结果提示，无眩晕或姿势平衡障碍病史的偏头痛患者存在前庭通路的亚临床改变。这一发现支持了偏头痛患者存在前庭-小脑功能障碍的假说，尤其是伴先兆的偏头痛患者。
