Buchholz D W, Reich S G
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland 21287-0876, USA.
Semin Neurol. 1996 Mar;16(1):83-93. doi: 10.1055/s-2008-1040963.
Migraine is conventionally regarded as a specific type of headache with a small set of associated neurologic symptoms. Yet, the true scope and frequency of migrainous phenomena are much greater than is generally acknowledged. Six cases are presented to illustrate some of the diverse manifestations of migraine: (1) transient global amnesia, (2) persistent visual phenomena, (3) migraine and seizures, (4) vestibular dysfunction, (5) hearing loss, and (6) migraine masquerading as multiple sclerosis. These and other migraine-associated neurologic symptoms are discussed in relation to previous reports in the literature. Pitfalls in recognizing the diverse manifestations of migraine, which are often underdiagnosed or misdiagnosed, are reviewed. Whether or not the established diagnostic criteria for migraine are too strict, other factors contributing to failure to identify migraine when it causes nonclassic neurologic symptoms include: (1) the belief that these are rare, (2) lack of an objective measure for migraine, (3) inadequate attention to the positive diagnostic features of migraine in the absence of headache, (4) confusion regarding prior migraine history, and (5) dismissing the diagnosis because of reported failure of prior migraine treatment. Recognition of the diversity of migraine helps avoid unnecessary testing and opens the door to effective treatment.
传统上，偏头痛被视为一种特定类型的头痛，伴有一小部分相关的神经症状。然而，偏头痛现象的真实范围和频率比普遍认知的要大得多。本文介绍了六个病例，以说明偏头痛的一些不同表现：（1）短暂性全面性遗忘症，（2）持续性视觉现象，（3）偏头痛与癫痫发作，（4）前庭功能障碍，（5）听力丧失，以及（6）伪装成多发性硬化症的偏头痛。结合文献中的先前报道，对这些以及其他与偏头痛相关的神经症状进行了讨论。回顾了在识别偏头痛的不同表现时所面临的陷阱，这些表现常常被漏诊或误诊。既定的偏头痛诊断标准是否过于严格，当偏头痛导致非典型神经症状时，其他导致未能识别偏头痛的因素包括：（1）认为这些情况罕见，（2）缺乏偏头痛的客观测量方法，（3）在没有头痛的情况下对偏头痛的阳性诊断特征关注不足，（4）对既往偏头痛病史的混淆，以及（5）因先前偏头痛治疗失败的报告而排除诊断。认识到偏头痛的多样性有助于避免不必要的检查，并为有效治疗打开大门。
