Russell M B, Olesen J
Department of Neurology, Glostrup Hospital, University of Copenhagen, Denmark.
Brain. 1996 Apr;119 ( Pt 2):355-61. doi: 10.1093/brain/119.2.355.
The study presented here is the first detailed nosographic analysis of migraine aura, diagnosed using the criteria of the International Headache Society, in a sufficiently large sample for statistical analysis. Of 4,000 people, 163 had migraine with aura. Sixty-two had attacks of migraine aura with headache as well as migraine aura without headache, and seven had exclusively migraine aura without headache. Visual symptoms were most frequent (99%), followed by sensory (31%), aphasic (18%) and motor (6%) symptoms. Those with several types of aura symptoms had visual aura in virtually every attack, while sensory, motor and aphasic aura were present only in a small number of their attacks. The typical visual aura starts as a flickering, uncoloured, zig-zag line in the centre of the visual field and affect the central vision. It gradually progresses towards the periphery of one hemifield and often leaves a scotoma. The typical sensory aura is unilateral, starts in the hand, progresses towards the arm and then affects the face and tongue. The typical motor aura is half-sided and affects the hand and arm. The visual, sensory and aphasic auras rarely lasted > 1 h, while the motor aura did in 67% (six out of nine). Four people had exclusively acute onset visual aura. The duration of the aura and the characteristics of the ensuing headache were typical for migraine with aura, suggesting that acute onset aura is a real phenomenon. Headache followed the aura in 93%, headache and aura occurred simultaneously in 4% and aura followed headache in 3%. The characteristic spread of each symptom and the sequence of different symptoms suggest that cortical spreading depression is the mechanism underlying the migraine aura. Our results do not suggest that alterations of the diagnostic criteria of the International Headache Society are needed. The intra-individual variation of aura symptoms shown in this study indicates that a simplification of the International Classification of Diseases, Neurological Adaptation is appropriate.
本文所呈现的研究是首次依据国际头痛协会的标准，对偏头痛先兆进行详细的疾病分类分析，样本量足够大，可用于统计分析。在4000人中，163人患有伴先兆偏头痛。62人既有伴有头痛的偏头痛先兆发作，也有无头痛的偏头痛先兆发作，7人仅有不伴有头痛的偏头痛先兆。视觉症状最为常见（99%），其次是感觉症状（31%）、失语症状（18%）和运动症状（6%）。有几种先兆症状类型的患者，几乎每次发作都有视觉先兆，而感觉、运动和失语先兆仅在少数发作中出现。典型的视觉先兆起始于视野中央的闪烁、无色、之字形线条，影响中心视力。它逐渐向一个半侧视野的周边发展，常留下暗点。典型的感觉先兆是单侧的，始于手部，向手臂发展，然后影响面部和舌头。典型的运动先兆是半侧性的，影响手部和手臂。视觉、感觉和失语先兆很少持续超过1小时，而运动先兆在67%（9例中的6例）中持续超过1小时。4人仅有急性起病的视觉先兆。先兆的持续时间以及随后头痛的特征符合伴先兆偏头痛的典型表现，提示急性起病的先兆是一种真实现象。93%的患者头痛在先兆之后出现，4%的患者头痛和先兆同时出现，3%的患者先兆在头痛之后出现。每种症状的特征性扩散以及不同症状的先后顺序表明，皮层扩散性抑制是偏头痛先兆的潜在机制。我们的结果并不表明需要改变国际头痛协会的诊断标准。本研究中所显示的先兆症状的个体内差异表明，简化《国际疾病分类，神经适应》是合适的。
