Sharif Sameer, Kotwal Susrutha, Edlow Jonathan A
Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, Johns Hopkins University School of Medicine, Boston, Massachusetts.
J Emerg Med. 2025 Jan;68:113-121. doi: 10.1016/j.jemermed.2024.07.002. Epub 2024 Aug 6.
Vestibular migraine (VM) is a subset of migraine and, as its name suggests, presents with both migrainous and vestibular symptoms. However, a more worrisome diagnosis that can present with similar features is posterior circulation transient ischemic attack (pc-TIA) presenting as episodes of isolated dizziness.
The purpose of this article is to introduce emergency physicians to the diagnostic features of VM focusing on epidemiological context, timing and quality of symptoms that help differentiate vestibular migraine from pc-TIA.
Our comprehensive search of epidemiologic data of VM patients found that they are more likely to be younger and female than patients with pc-TIA. Traditional vascular risk factors and a recent history of head or neck trauma are more common in pc-TIA patients. The onset of dizziness is sudden in pc-TIA with symptoms often lasting less than one hour. Moreover, symptoms tend to be positive in VM versus negative in pc-TIA.
Medical decision making should be individualized. A new nontriggered episode of isolated dizziness or those with new transient neurological findings should be evaluated for pc-TIA. VM should be considered in younger patients who have had multiple episodes over a greater time period with other migraine-related symptoms.
前庭性偏头痛（VM）是偏头痛的一个亚型，顾名思义，它同时伴有偏头痛症状和前庭症状。然而，一种更令人担忧的、可能表现出类似特征的诊断是后循环短暂性脑缺血发作（pc-TIA），其表现为孤立性头晕发作。
本文旨在向前急诊医生介绍VM的诊断特征，重点关注有助于将前庭性偏头痛与pc-TIA区分开来的流行病学背景、症状出现的时间和性质。
我们对VM患者的流行病学数据进行全面检索后发现，与pc-TIA患者相比，VM患者更可能为年轻女性。传统血管危险因素以及近期有头颈部外伤史在pc-TIA患者中更为常见。pc-TIA患者头晕起病突然，症状通常持续不到1小时。此外，VM症状往往为阳性，而pc-TIA症状往往为阴性。
医疗决策应个体化。对于新发的孤立性头晕发作或伴有新的短暂性神经学表现的患者，应评估是否为pc-TIA。对于在较长时间内有多次发作且伴有其他偏头痛相关症状的年轻患者，应考虑VM。
