Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA.
J Vestib Res. 2022;32(5):453-463. doi: 10.3233/VES-210117.
Current Bárány Society criteria for vestibular migraine (VM) include only episodic symptoms. Anecdotal observations suggest that some patients have episodic forms and others have chronic forms of VM, with interplay and evolution of both subtypes over time.
To better understand VM subtypes and evaluate a more inclusive diagnostic schema.
Four VM groups were studied: definite episodic (dVM), probable episodic (pVM), definite chronic (dCVM), and probable chronic (pCVM). Chronic VM was defined as having more than 15 dizzy days per month. Sociodemographic and clinical characteristics were analyzed, along with Dizziness Handicap Inventory (DHI) and Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores.
54 adults with a mean age of 47.0 years (SD 13.7) were enrolled. 10 met criteria for dVM, 11 pVM, 22 dCVM, and 11 pCVM. Overall, there were strong similarities in clinical characteristics between dVM, pVM, dCVM, and pCVM. Compared to subjects with episodic VM, those with chronic VM had a higher average number of VM triggers (8.7 vs. 6.4, P = 0.019), including motion (93.9% vs. 66.7%, P = 0.009), scrolling on a screen (78.8% vs. 47.6%, P = 0.018), skipped meal (57.6% vs. 23.8%, P = 0.015), and air travel (57.6% vs. 23.8%, P = 0.015). They also had higher symptom severity (DHI = 53.3, P = 0.194) and burden of disease (VM-PATHI = 48.2, P = 0.030) scores.
Many patients do not meet current Bárány Society criteria for VM based on their duration of vestibular symptoms. Yet, these patients with chronic VM endorse several indistinguishable symptoms from those who do meet criteria. A more inclusive diagnostic schema should be adopted where patients with vestibular symptoms shorter than 5 minutes or longer than 72 hours are also recognized as having VM.
目前前庭性偏头痛（VM）的 Bárány 学会标准仅包括发作性症状。一些患者表现为发作性，另一些患者表现为慢性 VM，两种亚型随时间相互作用和演变。
更好地了解 VM 亚型并评估更具包容性的诊断方案。
研究了四个 VM 组：明确的发作性（dVM）、可能的发作性（pVM）、明确的慢性（dCVM）和可能的慢性（pCVM）。慢性 VM 的定义为每月有超过 15 天头晕。分析了社会人口统计学和临床特征，以及眩晕障碍量表（DHI）和前庭性偏头痛患者评估工具和障碍量表（VM-PATHI）评分。
共纳入 54 名平均年龄 47.0 岁（SD 13.7）的成年人。10 人符合 dVM 标准，11 人符合 pVM 标准，22 人符合 dCVM 标准，11 人符合 pCVM 标准。总体而言，dVM、pVM、dCVM 和 pCVM 之间的临床特征非常相似。与发作性 VM 患者相比，慢性 VM 患者的 VM 发作诱因平均数量更高（8.7 比 6.4，P=0.019），包括运动（93.9%比 66.7%，P=0.009）、屏幕滚动（78.8%比 47.6%，P=0.018）、错过进餐（57.6%比 23.8%，P=0.015）和航空旅行（57.6%比 23.8%，P=0.015）。他们的症状严重程度（DHI=53.3，P=0.194）和疾病负担（VM-PATHI=48.2，P=0.030）评分也更高。
许多患者根据其前庭症状的持续时间不符合目前的 Bárány 学会 VM 标准。然而，这些慢性 VM 患者的症状与符合标准的患者有一些无法区分的症状。应该采用更具包容性的诊断方案，将持续 5 分钟以下或超过 72 小时的患者也认定为 VM 患者。
