神经内科门诊前庭性偏头痛临床特征分析

Clinical features of vestibular migraine in a neurological clinic

摘要:

目的：分析神经内科门诊中前庭性偏头痛（vestibular migraine，VM）的临床特征，并对国际头痛疾病分类第三版测试版（International Classification of Headache Disorders-Ⅲ，beta version，ICHD-Ⅲ beta）中VM的诊断标准进行初步的临床实践测试。 方法：回顾性分析重庆医科大学附属第一医院神经内科门诊2013年6月至2014年6月39例VM患者的人口学特征以及临床特征，并对VM标准（ICHD-Ⅲ beta）进行临床实践测试分析。结果：偏头痛的平均起病年龄为（32.7±10.5）岁，眩晕的平均起病年龄为（36.6±10.3）岁。偏头痛亚类最常见的是无先兆性偏头痛（82%），其次是先兆性偏头痛（10%）和慢性偏头痛（8%）。眩晕类型以自发性眩晕为主（90%），眩晕发作持续时间从数秒至数天不等。最常见的伴随症状为畏光畏声（74%）。此外，33%的患者不满足VM诊断标准中的C标准，8%的患者不满足B标准。结论：神经内科门诊中VM患者的临床特征与国外的报道相似，但先兆性偏头痛患者的比例较国外低。VM的诊断标准（ICHD-Ⅲ beta）基本符合临床运用实践，但需要进一步改进，如眩晕发作时长的规定以及偏头痛亚型的更新。

Abstract:

Objective：To explore the clinical characteristics of vestibular migraine（VM） in a neurological clinic and to test the criteria of the International Classification of Headache Disorders 3rd edition beta version（ICHD-Ⅲ beta） in practice. Methods：Retrospective analysis was made on 39 patients with VM referred to the neurological clinic in the First Affiliated Hospital of Chongqing Medical U－niversity from June 2013 to June 2014. The demographic and clinical characteristics of these patients were analyzed. Results：The mean onset age of migraine was （32.7±10.5） years old and vertigo was （36.6±10.3） years old. The most common migraine subtype was migraine without aura（82%），followed by migraine with aura（10%） and chronic migraine（8%）. Spontaneous vertigo was reported in 90% patients and the duration of vestibular symptoms was varied from seconds to days. Photophobia and phonophobia（74%） were the most frequently reported associated symptoms. However，33% patients could not fulfill with criterion C and 8% patients could not fulfill with criterion B. Conclusion：The clinical features of VM in neurological clinic are similar with those in Western studies except the low proportion of migraine with aura among patients with VM. VM diagnostic criteria in ICHD-Ⅲ beta might be further modified，including the definition of vertigo episodes and the new-adding migraine subtypes.