偏头痛性眩晕与基底型偏头痛(附9例临床分析)

Migrainous vertigo and basilar migraine(Analyze the clinical symptoms of 9 migraine patients with vertigo)

目的分析9例偏头痛伴眩晕/头晕患者的临床及实验室检查结果,探讨头痛与眩晕/头晕的关系,以利正确诊治。方法作者医院收治的偏头痛伴眩晕/头晕患者9例,对所有患者均详细收集病史,并进行神经系统查体以及前庭功能、听力检查和头颅CT/MRI等实验室检查,以除外中枢性和耳源性眩晕。结果 9例偏头痛伴眩晕/头晕患者中,基底型偏头痛2例,无先兆偏头痛3例,偏头痛性眩晕(migrainous vertigo,MV)6例(其中2例为无先兆偏头痛发作数年后和50岁后转变为MV)。本组6例MV患者中,眩晕/头晕在头痛发作前数秒钟～1h内发生3例,在头痛发作后发生1例,与头痛同时发生1例,另1例偏头痛患者其头痛与眩晕从未同时发作过,为偏头痛等位征。结论 MV是不同于基底型偏头痛的头痛伴眩晕综合征,二者易与梅尼埃病、良性复发性位置性眩晕、后循环缺血(posterior circulation ischemia,PCI)等周围性和中枢性眩晕混淆或并存,临床应注意鉴别。

Objective By analysing the results of clinical and laboratory examinations in 9 migraine patients with vertigo or dizziness, we aimed to recognize the relationship between migraine and vertigo, and to improve the diagnosis and treatments of the patients. Methods Nine migraine patients with vertigo/dizziness were selected from our hospital. Besides the detailed questionnaire on the medical history, clinical and laboratory examinations, including neurological examination, vestibule functioning, hearing tests and head CT/MRI, were adopted in each patient, so as to exclude the cases caused by central and vestibule related vertigo. Results Among the 9 migraine patients with vertigo/dizziness, there were 2 cases of basilar migraine, 3 cases of migraine without aura, and 6 cases of migrainous vertigo （MV, in which 2 migraine patients changed to MV）. In the 6 MV patients, vertigo or dizziness occurred several seconds to one hour prior to the headache in 3 cases, post headache in 1 case and simultaneously with headache in 1 case. There was one migraine case, whose headache never occurred together with vertigo, called migraine equivalent. Conclusions MV is a special type of migraine syndrome associated with vertigo or dizziness due to basilar migraine. The diagnosis needs to be distinguished clearly from Meniere＇ s disease, benign paroxysmal positional vertigo, posterior circulation ischemia （PCI）, etc.