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[前庭性偏头痛的临床特征分析]

[Analysis of clinical features of vestibular migraine].

作者信息

Duan Fujun, Xu Xianrong, Zhang Dan, Li Shaen, Jin Zhanguo, Zhang Yang

机构信息

Vertigo Clinic Research Center of Aerospace,Air Force Medical Center,PLA,Beijing,100142,China.

Department of Avation Disease,Air Force Hospital of Southern Theater Command,PLA.

出版信息

Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2020 Aug;34(8):726-730. doi: 10.13201/j.issn.2096-7993.2020.08.011.

Abstract

To analyze the clinical features of Vestibular migraine(VM) and provide evidence for its accurate diagnosis and medical identification of flight personnel. A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo(BPPV), and 11 samples were co-occurring with Meniere's disease(MD). All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months. ①The male-female ratio of VM patients was 1∶1.95, the average age was (50.2±14.3) years old, (48.7±15.0) years old for males and (51.0±13.9) years old for females. No statistically significant differences were found(>0.05). The average duration was(54.5±84.8) months, (35.0±59.0) months for males and(64.7±94.0) months for females. The difference was statistically significant(<0.05). ②The main clinical symptoms are dizziness, migraine or previous history of migraine, fear of sound/noisy environment sensitivity, photophobia/visual sensitivity, nausea/vomiting, vestibular posture symptoms, tinnitus, hearing loss, etc. , diarrhea during dizziness or headache was one special symptom of VM; ③The abnormal rate of vestibular autorotation test(VAT) in 118 VM patients was 72.3%, while the abnormal rate of caloric test in 170 VM patients was 32.9%; ④The effective remission rate within 6 months of VM patients with secondary BPPV and MD was 78.6% and 83.4%, while the VM patients without secondary benign paroxysmal positional vertigo(BPPV) and Meniere's disease(MD) was 93.3%. The difference was statistically significant(<0.05). The clinical manifestations of VM patients were various. Female VM patients had higher incidence, the course of disease than male VM patients, diarrhea can be regarded as one of the clinical features distinguished from MD. The abnormal rate of VAT was higher in the common clinical examiniations of VM patients. VM patients treatment should focus on personalized prescription and lifestyle management, vestibular rehabilitation, and corresponding treatment at the same time should be given to patients with secondary BPPV and MD to improve the efficacy. The medical identification of flight personnel VM patients should be strictly controlled, pilots should be grounded, while flight combat personnel and flight technical personnel need chartered medical identification.

摘要

分析前庭性偏头痛(VM)的临床特征,为飞行人员的准确诊断及医学鉴定提供依据。共收集490例VM患者样本。其中,88例继发于良性阵发性位置性眩晕(BPPV),11例与梅尼埃病(MD)并存。所有患者均接受药物、生活方式管理、前庭康复等综合治疗,并分析6个月内的临床特征及疗效。①VM患者男女比例为1∶1.95,平均年龄为(50.2±14.3)岁,男性为(48.7±15.0)岁,女性为(51.0±13.9)岁。差异无统计学意义(>0.05)。平均病程为(54.5±84.8)个月,男性为(35.0±59.0)个月,女性为(64.7±94.0)个月。差异有统计学意义(<0.05)。②主要临床症状为头晕、偏头痛或既往偏头痛病史、畏声/对嘈杂环境敏感、畏光/视觉敏感、恶心/呕吐、前庭姿势症状、耳鸣、听力下降等,头晕或头痛时腹泻是VM的一个特殊症状;③118例VM患者前庭自旋转试验(VAT)异常率为72.3%,170例VM患者冷热试验异常率为32.9%;④继发BPPV和MD的VM患者6个月内有效缓解率分别为78.6%和83.4%,而无继发良性阵发性位置性眩晕(BPPV)和梅尼埃病(MD)的VM患者为93.3%。差异有统计学意义(<0.05)。VM患者临床表现多样。女性VM患者发病率高于男性,病程长于男性,腹泻可视为与MD相鉴别的临床特征之一。VM患者常见临床检查中VAT异常率较高。VM患者治疗应注重个性化处方及生活方式管理、前庭康复,同时对继发BPPV和MD的患者应给予相应治疗以提高疗效。对飞行人员VM患者的医学鉴定应严格把控,飞行员应停飞,而飞行作战人员和飞行技术人员需进行特许医学鉴定。

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