Xiao B J, Bi Y, Zheng T H
Department of Neurology, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, 200081, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2019 Jul;33(7):577-580. doi: 10.13201/j.issn.1001-1781.2019.07.001.
The aim of this study is to investigate the predisposing factors and the effect of healthy education on recurrence of vestibular migraine (VM), so as to provide a scientific basis for increasing the knowledge rate and reducing the recurrence rate of VM patients. Questionnaires, memory diary, regular follow-up, etc. were used to understand the possible predisposing factors of VM patients. Self-assessment depression scale (SDS) and self-assessment anxiety scale (SAS) were used to evaluate patients' mental and psychological status, and visual analogue scale (VAS) was used to evaluate the severity of vertigo. Health education was conducted for VM patients through face-to-face consultation, material distribution, modern multimedia and other methods. The knowledge rate, anxiety and fear psychological state, recurrence frequency of vertigo, duration and severity of vertigo were compared before and after the healthy education. Of 103 cases of the object of study, 100 patients (97.1%) with different degree of sleep disorders, 96 cases (93.2%) had a clear family history with vertigo or dizziness headache, 90 cases (87.4%) had history of motion sickness, 90 cases (87.4%) had confined space history of intolerance, 82 cases (79.6%), recurrent cause psychological anxiety, fear, 80 cases (77.7%), lack of exercise, 79 cases (76.7%) under pressure from life or work, 53 (51.5%) had food preference, 8 cases (7.8%) think much rain attacks more frequent when humid climate,seven (6.8%) reported more episodes during the spring or spring/summer exchanges.After health education, patients were followed up for 6 months to 2 years with a median of 15 months, and their knowledge rate of VM was increased from 12.6% (13 cases) to 98% (101 cases).The psychological ratio of anxiety and fear decreased from 79.6% (82 cases) to 7.8% (8 cases).The SAS score decreased from 47.9±4.4 to 45.5±4.2, and the SDS score decreased from 39.7±3.6 to 38.2±3.8.The unhealthy lifestyle and eating habits (lack of exercise, stress, and eating preferences at least 1 item)decreased from 89.4% (92 cases) to 32.1% (33 cases).The recurrence rate of 83.5% (86 cases) of the patients was reduced by 1 time or more, and the rate of no recurrence increased from 1% (1 case) to 15.5% (16 cases) within half a year.The duration of the attack was reduced by 20% or more in 48.5%(50 cases),The mean duration of the attack declined from (17.4±1.4) hours before healthy education to (10.5±0.9) hours after healthy education.The VAS score of 86.4%(89 cases) with recurrence severity decreased by 2 points or more. The average VAS score before and after education was (6.6±0.1) points and (4.5±0.1) points respectively.The above differences were statistically significant (<0.01) compared with those before and after education. Sleep disorder, airtight space intolerance, excessive stress, lack of exercise, and dietary preference may be related factors to trigger VM attacks. Healthy education can significantly improve the awareness of VMs, and promote patients to change their lifestyle and eating habits. It can significantly improve patients' anxiety and fear psychological state, reduce the frequency of attack, shorten the duration of attack, and reduce the severity of selfassessment, which is worthy of clinical promotion.
本研究旨在探讨前庭性偏头痛(VM)复发的诱发因素及健康教育的作用,为提高VM患者的知晓率和降低复发率提供科学依据。采用问卷调查、记忆日记、定期随访等方式了解VM患者可能的诱发因素。采用自评抑郁量表(SDS)和自评焦虑量表(SAS)评估患者的精神心理状态,采用视觉模拟评分法(VAS)评估眩晕严重程度。通过面对面咨询、发放资料、现代多媒体等方式对VM患者进行健康教育。比较健康教育前后患者的知晓率、焦虑恐惧心理状态、眩晕复发频率、眩晕持续时间及严重程度。研究对象103例中,100例(97.1%)有不同程度的睡眠障碍,96例(93.2%)有明确的眩晕或头晕头痛家族史,90例(87.4%)有晕动病史,90例(87.4%)有密闭空间不耐受史,82例(79.6%)复发原因是心理焦虑、恐惧,80例(77.7%)缺乏运动,79例(76.7%)生活或工作压力大,53例(51.5%)有饮食偏好,8例(7.8%)认为潮湿气候下雨时发作更频繁,7例(6.8%)报告在春季或春夏季交替时发作更频繁。健康教育后,对患者随访6个月至2年,中位随访时间15个月,患者对VM的知晓率从12.6%(13例)提高到98%(101例)。焦虑恐惧心理比例从79.6%(82例)降至7.8%(8例)。SAS评分从47.9±4.4降至45.5±4.2,SDS评分从39.7±3.6降至38.2±3.8。不健康的生活方式和饮食习惯(缺乏运动、压力大、饮食偏好至少1项)从89.4%(92例)降至32.1%(33例)。83.5%(86例)患者的复发率降低1次及以上,半年内无复发率从1%(1例)提高到15.5%(16例)。48.5%(50例)患者发作持续时间缩短20%及以上,健康教育前发作平均持续时间为(17.4±1.4)小时,健康教育后为(10.5±0.9)小时。86.4%(89例)复发严重程度的VAS评分降低2分及以上。教育前后平均VAS评分分别为(6.6±0.1)分和(4.5±0.1)分。上述差异与教育前后比较,差异有统计学意义(<0.01)。睡眠障碍、密闭空间不耐受、压力过大、缺乏运动和饮食偏好可能是触发VM发作的相关因素。健康教育能显著提高对VM的认识,促使患者改变生活方式和饮食习惯。能显著改善患者焦虑恐惧心理状态,减少发作频率,缩短发作持续时间,降低自评严重程度,值得临床推广。