前庭性偏头痛的谱系：临床特征、诱因和检查结果。
The Spectrum of Vestibular Migraine: Clinical Features, Triggers, and Examination Findings.
机构信息
Department of Neurology, UT Southwestern Medical Center, Dallas, TX, USA.
Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA.
出版信息
Headache. 2019 May;59(5):727-740. doi: 10.1111/head.13484. Epub 2019 Feb 8.
OBJECTIVE
To assess the ictal symptoms, interictal symptoms, psychiatric comorbidities, and interictal neuro-otologic examination findings in vestibular migraine (VM).
METHODS
Retrospective chart review of 491 patients seen from August 2014 until March 2018 at a tertiary neurology referral center for vestibular disorders to identify patients fulfilling the 2012 VM criteria.
RESULTS
One hundred and thirty-one patients (105 women) were identified. Mean age of VM onset was 44.3 (±13.7) years. Preceding the onset of vestibular symptoms, most had migraine (57.3%) and motion sickness (61.1%). It was common to have a family history of migraine (50.8%) and episodic vestibular symptoms (28.1%). Common ictal symptoms were triggered (visually induced and head-motion) and spontaneous vertigo, accompanied by photophobia and phonophobia (118/131 [90.1%] patients), nausea (105/131 [80.2%] patients), aural symptoms (79/131 [60.3%] patients), and headache (65/131 [49.6%] patients). Interictally, many experienced visually induced (116/131 [88.6%] patients), head-motion (86/131 [65.6%] patients), and persistent (67/131 [51.1%] patients) dizziness. Psychiatric comorbidities include anxiety (92/131 [70.2%] patients), depression (53/131 [40.5%] patients), insomnia (38/131 [29.0%] patients), phobic disorders (15/131 [11.5%] patients), and psychogenic disorders (11/131 [8.4%] patients). Common triggers were stress (52/131 [39.7%] patients), bright lights (35/131 [26.7%] patients), weather changes (34/131 [26.0%] patients), and sleep deprivation (34/131 [26.0%] patients). Interictal neuro-otologic examination was abnormal in 56/131 (42.7%), usually hyperventilation-induced, head-shaking-induced, vibration-induced, and positional nystagmus. The most common balance-test finding was impaired sharpened Romberg's test (22/130 [16.9%] patients).
CONCLUSIONS
In this single center study, we found that VM typically affects women in their 40s, with a personal and family history of migraine. Typical ictal symptoms were triggered and spontaneous vertigo, associated with photophobia and phonophobia, nausea, aural symptoms, and headache. Interictal vestibular symptoms, comorbid psychiatric disorders, and non-specific interictal neuro-otologic findings were common.
目的
评估前庭性偏头痛（VM）患者的发作期症状、发作间期症状、精神共病和发作间期神经耳科学检查结果。
方法
对 2014 年 8 月至 2018 年 3 月在一家三级神经转诊中心就诊的前庭障碍患者进行回顾性图表审查，以确定符合 2012 年 VM 标准的患者。
结果
共发现 131 例患者（105 例女性）。VM 发病的平均年龄为 44.3（±13.7）岁。在出现前庭症状之前，大多数患者有偏头痛（57.3%）和运动病（61.1%）。有偏头痛家族史（50.8%）和间歇性前庭症状史（28.1%）很常见。常见的发作期症状包括视觉诱发和头部运动诱发的眩晕，伴有畏光和畏声（131 例中有 118 例[90.1%]）、恶心（131 例中有 105 例[80.2%]）、耳部症状（79 例中有 79 例[60.3%]）和头痛（65 例中有 65 例[49.6%]）。发作间期，许多患者出现视觉诱发（131 例中有 116 例[88.6%]）、头部运动诱发（131 例中有 86 例[65.6%]）和持续性（131 例中有 67 例[51.1%]）头晕。精神共病包括焦虑（131 例中有 92 例[70.2%]）、抑郁（131 例中有 53 例[40.5%]）、失眠（131 例中有 38 例[29.0%]）、恐惧症（131 例中有 15 例[11.5%]）和心因性障碍（131 例中有 11 例[8.4%]）。常见的诱因包括压力（52 例中有 52 例[39.7%]）、亮光（35 例中有 35 例[26.7%]）、天气变化（34 例中有 34 例[26.0%]）和睡眠不足（34 例中有 34 例[26.0%]）。56/131（42.7%）例发作间期神经耳科学检查异常，通常为过度换气诱发、摇头诱发、振动诱发和位置性眼震。最常见的平衡测试发现是锐化 Romberg 测试异常（130 例中有 22 例[16.9%]）。
结论
在这项单中心研究中，我们发现 VM 通常影响 40 多岁的女性，有偏头痛的个人和家族史。典型的发作期症状包括视觉诱发和自发性眩晕，伴有畏光和畏声、恶心、耳部症状和头痛。发作间期的前庭症状、共病精神障碍和非特异性发作间期神经耳科学检查结果较为常见。
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