确诊型前庭性偏头痛42例临床特征及相关检测 结果分析

目的:分析确诊型前庭性偏头痛(dVM)的临床特征及相关检测结果,优化dVM诊断标准。方法:按照Bárány学会诊断标准,纳入就诊于我院的d VM患者42例,对其临床资料进行回顾性分析。结果:本组患者年龄为24～68岁,平均(48.9±11.9)岁;男女比例为1:4.3。38.1%(16例)为头运动诱发眩晕,61.9%(26例)为自发性眩晕;64.3%(27例)d VM患者发作持续时间1 h;73.8%(31例)为无先兆偏头痛,52.4%(22例)的患者偏头痛起病早于前庭症状;81.0%(34例)患者有畏光、畏声的表现;50.0%(21例)有晕动症,26.2%(11例)患者伴听力受损,温度试验后33.3%(14例)患者伴单侧半规管功能减低,同时有40.5%的患者伴温度试验不耐受。30.9%(13例)的dVM患者中枢眼动异常,38.1%(16例)免疫相关指标异常患者,其中血清甲状腺抗体阳性10例(62.5%)。结论:dVM以女性多见,眩晕多呈自发发作,症状持续时间多1 h,偏头痛起病多早于前庭症状,发作时多伴畏光畏声;晕车史及双温试验不耐受亦不少见。     

Migraine and vestibular symptoms--identifying clinical features that predict "vestibular migraine"

Background.— Migraine and symptoms that may suggest a vestibular disorder (referred to herein broadly as vestibular symptoms—VS) often co‐exist. In part due to a lack of standardized diagnostic criteria, this relationship remains unknown to many physicians. Objective.— To determine common clinical features that may be associated with “vestibular migraine” (VM). Methods.— We retrospectively reviewed charts of patients diagnosed with VM at a headache center. In this group we recorded certain demographic and clinical features related to their disorder, including the most common triggers of the VS and the specific characteristics of the symptoms that suggested VM. Results.— Our sample consisted of 147 patients (68% women, mean age = 45 years, 39% with aura). Migraine onset preceded the onset of VS by a mean of 8 years. A total of 62 patients (42%) had gradual onset of VS, while in 48 (33%) symptoms began suddenly. The most commonly reported symptoms that led to the diagnosis of VM were: unsteadiness (134; 91%), balance disturbance (120; 82%), “light‐headedness” (113; 77%), and vertigo (84; 57%). VS and headache occurred concomitantly in 48% of patients. A total of 67 (47%) patients had VS that were chronic from onset, 29 (21%) had episodic symptoms, and in 46 (32%) the VS had evolved from episodic to chronic (with an average duration of 7.04 years required for this evolution to occur). Conclusions.— Vestibular migraine is a heterogeneous condition with varying symptomatology. As with migraine itself, symptomatic expression varies along a spectrum that extends from episodic to chronic. As the histories of many of the patients we evaluated would not meet current International Classification of Headache Disorders criteria, we suggest that new criteria which account for the heterogeneity and natural history of the disorder may be required to adequately diagnose and treat those who suffer from VM.     

Horizontal Direction‐Changing Positional Nystagmus and Vertigo: A Case of Vestibular Migraine Masquerading as Horizontal Canal BPPV

Episodic positional vertigo is typically due to benign paroxysmal positional vertigo (BPPV) but may also be a manifestation of vestibular migraine. Distinguishing vestibular migraine from BPPV is essential since the treatment of each disorder is markedly different. The 31‐month clinical course of a 41‐year‐old woman with vestibular migraine causing recurrent positional vertigo is described. During vestibular migraine attacks, she developed left‐beating nystagmus in the upright position with removal of fixation, and geotropic horizontal nystagmus during the supine roll test. Interictally, her exam demonstrated positional apogeotropic horizontal nystagmus with the supine roll test, more intense in the supine head left position. Her vestibular migraine was successfully controlled with topiramate and eletriptan.     

Vestibular Pathways Involvement in Children With Migraine: A Neuro-Otological Study

( Headache 2010;50:71-76)
Objective.— To assess, during symptom free intervals, the clinical, audiological, and vestibular findings in a cohort of child migraine sufferers, with or without vertigo or dizziness or both.
Background.— In adults and children, dizziness and vertigo are frequently associated with migraine.
Methods.— Twenty-two child migraine sufferers with vestibular symptoms, aged 7-13 years (group A), and 18 child migraine sufferers without vestibular symptoms, aged 8-13 (group B) entered our study between January 2007 and June 2007. The characteristics of auditory functions and vestibular symptoms and signs were assessed and reviewed by a blinded physician.
Results.— The whole sample was found audiologically normal. In group A, 6 subjects had normal vestibular test results, whereas vestibular testing disclosed either peripheral or central sufferance or both, in the remaining 16 patients (73%). Twelve subjects from group B had normal vestibular test results whereas positive vestibular test results were reported in the remaining 6 subjects (33%).
Conclusions.— This single-blind work outlines the brain stem abnormalities in children with migraine in the form of direct involvement of peripheral or central vestibular pathways or both. Interestingly, some children with migraine but without vestibular symptoms also had abnormal results at vestibular testing. This could demonstrate a subclinical involvement of vestibular pathways without clinical presentation. The subjects are still being followed up to evaluate the evolution of symptomatology.     

Migraine Mimics

The symptoms of migraine are non‐specific and can be present in many other primary and secondary headache disorders, which are reviewed. Even experienced headache specialists may be challenged at times when diagnosing what appears to be first or worst, new type, migraine status, and chronic migraine.     

Vestibular Function in Migraine

SYNOPSIS
In order to evaluate vestibular function in migraine, electronystagmography (ENG) was used. Twenty migrainous patients in the headache free phase and free of drugs for at least one week prior to study, were studied. The ENG examination included spontaneous eye movements, bithermal caloric tests and rotatory tests.
The results showed vestibular abnormalities in sixteen patients (80%). Spontaneous nystagmus was found in nine patients (45%). Sixteen patients (80%) had adnormal caloric tests and fifteen (75%) had adnormal rotatory tests.
These findings suggest impairment in vestibular function in a large proportion of migrainous patients. The significance and a possible mechanism are discussed.     

Migraine,Migraine Features,and Cardiovascular Disease

(Headache 2010;50:1031‐1040) Background.— Many studies support an association between migraine and cardiovascular disease (CVD). This association appears particularly in migraine with aura and is also modified by additional factors. Objective.— We sought to investigate whether the association between migraine and CVD in addition to aura status is affected by certain migraine features. Methods.— Cohort study among 27,840 women, participating in the Women's Health Study. We had detailed self‐reported information on migraine and migraine features among women with active migraine (migraine during the year prior to baseline). Incident CVD events were confirmed after medical record review. We used Cox proportional hazards models to evaluate the association between migraine and incident CVD. The results have been presented in part before. We ran additional analyses according to migraine features. Results.— At baseline, 5125 (18.4%) women reported history of migraine; 39.7% of the 3610 women with active migraine indicated aura. During a mean of 11.9 years of follow‐up, 708 CVD events occurred. Migraine with aura doubled the risk for CVD, ischemic stroke, and myocardial infarction. With regard to ischemic stroke, this association seemed stronger in the absence than in the presence of migraine features. This was most pronounced in the absence (hazard ratio = 3.27; 95% CI = 1.93‐5.51; P < .0001) than in the presence of nausea/vomiting (hazard ratio = 0.91; 95% CI = 0.43‐1.93; P = .80). In contrast, the association with myocardial infarction did not reveal a certain pattern. Conclusions.— These data suggest that the association between migraine with aura and ischemic stroke may differ by absence or presence of migraine features.     

Menstrual Migraine in Adolescents

Objective.— To characterize menstrually associated headaches and migraine in adolescent girls and identify any developmental and pubertal changes. Background.— Headache and migraine is a common problem in adolescents with a transition to adult patterns. One pattern of adult migraine is the menstrual association in a significant number of women. Methods.— A retrospective analysis was performed of characteristics of adolescent's headaches including association with menstrual pattern. A detailed analysis of the patient‐ and parent‐reported headache characteristics and patterns of longitudinal change with development and puberty was reviewed, including timing of headache with age and menstrual period and progression of these events over the adolescence. Results.— Of the 896 girls between 9 and 18 years old reviewed at initial evaluation, 331 (50.3% of menarchal girls and 36.9% of all girls) report experiencing headaches with their menstrual period. Of those reporting a menstrual pattern, 63.6% reported migraines starting between day ?2 and +3 of their menstrual period start. Girls with menstrual migraine reported increased associated symptoms compared with girls without menstrual migraine. There was no difference in disability between girls with a menstrual pattern and those without a menstrual pattern (t = 1.64; P = .10). Additionally, 160 girls reported a monthly pattern to their headaches prior to beginning menstruation, suggestive of a menstrually related migraine pattern prior to menstruation. Conclusions.— The pattern of menstrual association begins to become apparent during adolescence. Once the menstrual pattern has developed, this association is stable. Early identification of this pattern has potential long‐term benefit for improved lifelong outcome.     

Migraine with prolonged aura

We present the case of a 29-year-old man with a long history of migraine with aura, in whom migraine with prolonged aura was induced after the sudden withdrawal of prophylactic therapy.     

Complicated Retinal Migraine

SYNOPSIS
Retinal migraine is not uncommon, but permanent sequelae are rare. We describe the case of a 23-year-old woman who had suffered from retinal migraine for five years. After a typical migraine attack a left nasal quadranopsia persisted. Fluorescein angiography showed a branch retinal arterial occlusion. Other causes were ruled out by appropriate laboratory techniques. Her visual field defect has persisted for eleven months.