Zhang Ai Juan, Yu Li Qun, Zhou Li, Cong Xian Zhu, Liu Qi Hui, Li Wen, Zhang Ai Yuan
Department of Neurology, Weifang People's Hospital, Weifang 261041, Shandong, China.
Epidemiology and Health Statistics, Weifang Medical College, Weifang, Shandong, China.
J Clin Med Res. 2024 Mar;16(2-3):63-74. doi: 10.14740/jocmr5088. Epub 2024 Mar 16.
Migraine, vestibular migraine (VM) and tension-type headache (TTH) are the most common disorders in dizziness and headache clinics, associated with dizziness or vertigo and postural imbalance, causing a substantial burden on the individual and the society. The objective of this research was to examine the presence of spontaneous nystagmus, comorbidity of benign paroxysmal positional vertigo (BPPV), and Tumarkin fall in patients; additionally, the study focused on assessing the patients' responses to bithermal caloric irrigation and video head impulse test (vHIT).
Consecutive patients diagnosed with migraine, VM, and TTH according to the International Classification of Headache Disorders, third edition (beta version (ICHD-3β)), who were referred to Dizziness and Headache Clinic were enrolled. BPPV and Tumarkin fall were assessed by questionnaires. The presence of BPPV was further evaluated through Dix-Hallpike or head roll maneuver, while spontaneous nystagmus was monitored using video-oculography during interictal period. Lastly, patients' responses to bithermal caloric irrigation and vHIT were analyzed.
There was a significantly higher incidence of spontaneous nystagmus in VM compared to both migraine and TTH. The drop attack episodes were slightly more frequent in VM than in TTH and migraine, though not statistically significant. The prevalence of BPPV was significantly higher in VM than in migraine and TTH. Unilateral vestibular paresis was more common in the VM group than in migraine and TTH. There was profound unilateral weakness (UW) in VM patients than in migraine, but no significant difference was found between VM and TTH. In VM, the percentage of saccades along with reduced vHIT gain was significantly higher than in migraine. Lastly, the percentage of abnormal response in vHIT was significantly lower than the percentage of abnormal UW in caloric irrigation across all groups.
In VM patients, the prevalences of decompensated peripheral damage and BPPV were higher than in migraine and TTH patients as disclosed by the presence of peripheral spontaneous nystagmus and abnormal vHIT during the interictal period. Our findings suggest that the peripheral vestibular system acts as a significant mechanism in the pathogenesis of VM, and it might also be involved in migraine and TTH cases without vertigo symptoms.
偏头痛、前庭性偏头痛（VM）和紧张型头痛（TTH）是头晕和头痛门诊最常见的疾病，与头晕或眩晕及姿势性失衡相关，给个人和社会造成了沉重负担。本研究的目的是检查患者是否存在自发性眼震、良性阵发性位置性眩晕（BPPV）合并症以及图马尔金跌倒；此外，该研究还着重评估患者对冷热试验和视频头脉冲试验（vHIT）的反应。
纳入根据《国际头痛疾病分类》第三版（β版（ICHD-3β））诊断为偏头痛、VM和TTH并转诊至头晕和头痛门诊的连续患者。通过问卷评估BPPV和图马尔金跌倒情况。通过Dix-Hallpike试验或摇头试验进一步评估BPPV的存在情况，而在发作间期使用视频眼震图监测自发性眼震。最后，分析患者对冷热试验和vHIT的反应。
与偏头痛和TTH相比，VM患者自发性眼震的发生率显著更高。VM患者的跌倒发作次数略多于TTH和偏头痛患者，尽管差异无统计学意义。VM患者中BPPV的患病率显著高于偏头痛和TTH患者。VM组单侧前庭功能减退比偏头痛和TTH更常见。VM患者的严重单侧无力（UW）比偏头痛患者更严重，但VM与TTH之间无显著差异。在VM中，vHIT增益降低时扫视的百分比显著高于偏头痛。最后，所有组中vHIT异常反应的百分比显著低于冷热试验中UW异常的百分比。
如发作间期外周自发性眼震和vHIT异常所示，VM患者中失代偿性外周损害和BPPV的患病率高于偏头痛和TTH患者。我们的研究结果表明，外周前庭系统是VM发病机制中的一个重要机制，它也可能参与无眩晕症状的偏头痛和TTH病例。
