前庭型偏头痛102例临床特征分析

Clinical characteristics of vestibular migraine in 102 patients

目的总结前庭型偏头痛的临床表现、检查和治疗效果。方法回顾分析2012年12月~2013年9月确诊为前庭型偏头痛的102例患者的临床资料。年龄7~71岁,平均42.2岁。结果男女比例为1∶4.1,30~60岁是发病高峰。33.3%(34/102)有家族发病史。眩晕多数为数月发作1次,眩晕持续时间多为数分钟到数日。76.5%(78/102)能提供可能的诱因,14例主诉怕冷。只有9.8%患者主诉头痛。14例变动体位诱发眩晕,28例有晕车史。79例听力正常;28例完成平衡台检查,前庭功能17例正常、11例异常。随访中5例为继发良性阵发性位置性眩晕。10例完成颈性前庭诱发肌源性电位检查,结果均正常。84.3%患者曾误诊,多为梅尼埃病。35例仅采取饮食和生活方式改变,避免触发因素控制症状,67例采用药物治疗。结论前庭型偏头痛患者常不主诉头痛,容易漏诊、误诊,认识偏头痛伴随症状有助诊断。改变饮食和生活方式,结合药物治疗,眩晕和头痛都可迅速得到控制。

Objective To summarize the clinical features in patients with vestibular migraine and to improve the understanding of this disease. Methods A retrospective analysis of the clinieal data of 102 patients with vestibular migraine between December 2012 to September 2013, aging from 7 to 71 years （ mean age 42.2 years） was conducted. Results The male to female ratio was 1 ： 4. 1, the peak incidence age was in 30 - 60 years. Thirty-four （ 33.3% ） patients had a family history of the disease. The frequency of vertigo attack was mostly once in several months, the durations were from several minutes to several days. Seventy-eight （76.5%） patients could provide possible causes, 14 eases complained fear of cold. Only 9.8% patients complained of headache initiatively. Fourteen cases suffered positional vertigo. Twenty-eight cases had motion sickness. Seventy-nine cases had normal hearing. Twenty-eight patients completed the posturography to test the vestibular function, in which 17 cases were normal and 1 l cases were abnormal. Five cases was identified with secondary benign paroxysmal positional vertigo during follow-up. Ten patients received cervical vestibular evoked myogenic potentials examination and the resuhs were normal. 84.3% patients experienced misdiagnosis and it was usually misdiagnosed as M^ni^re disease. Thirty-five cases recovered only after changing diet and lifestyle and avoiding triggering factors. Sixty-seven cases were treated successfully with drug administration. Conclusions The patients with vestibular migraine often do not complain of headaches, and are frequently misdiagnosed. Understanding of migraine associated symptoms is helpful to establish accurate diagnosis. The dizziness and headache could quickly be relieved by diet and lifestyle changes or medication.