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前庭性偏頭痛
前庭性偏頭痛共病 Scott EGGERS1, Brian NEFF2, Neil SHEPARD3, Jeffrey STAAB4 1 美國，明尼蘇達(dá)州，羅切斯特，梅奧診所，神經(jīng)內(nèi)科 2 美國，明尼蘇達(dá)州，羅切斯特，梅奧診所，耳鼻喉科 3 美國，明尼蘇達(dá)州，羅切斯特，梅奧診所，聽力學(xué)科 4 美國，明尼蘇達(dá)州，羅切斯特，梅奧診所，精神心理科 根據(jù)目前共識(shí)，前庭性偏頭痛的診斷主要依賴兩個(gè)方面的癥狀：發(fā)作性的前庭癥狀及時(shí)間相關(guān)的偏頭痛性癥狀。前庭性偏頭痛的前庭性癥狀及頭痛特點(diǎn)目前尚未達(dá)成共識(shí)。不足的偏頭痛特征可能妨礙了長期發(fā)作性眩暈伴有頭痛癥狀患者的診斷，而這些患者本應(yīng)診斷為前庭性偏頭痛。另外，共病狀態(tài)的頻繁存在提示第三方面診斷的不確定性，使前庭性偏頭痛診27斷標(biāo)準(zhǔn)在臨床應(yīng)用與研究產(chǎn)生混亂。多種與前庭性偏頭痛同時(shí)發(fā)生的神經(jīng)耳科學(xué)癥狀在偏頭痛患者中發(fā)生率更高，包括良性陣發(fā)性位置性眩暈，梅尼埃病，暈動(dòng)癥。前庭性偏頭痛患者有較高的持續(xù)性位置感覺性頭暈（persistent postural-perceptual dizziness，PPPD）發(fā)生率。PPPD 的特征為慢性與運(yùn)動(dòng)相關(guān)的非旋轉(zhuǎn)性頭暈、不穩(wěn)感（通常每日）。由于前庭性偏頭痛診斷標(biāo)準(zhǔn)及病理生理學(xué)的完善，前庭癥狀的類型及最長持續(xù)時(shí)間是區(qū)分前庭性偏頭痛與其他獨(dú)立綜合征狀如PPPD 最核心的因素。我們的臨床藥理學(xué)試驗(yàn)顯示前庭性偏頭痛與PPPD 共病的患者使用舍曲林后PPPD 特征性癥狀改善，這表明前庭性偏頭痛患者出現(xiàn)慢性前庭癥狀存在PPPD 共病，而不是一種慢性型前庭性偏頭痛。為了更深入地了解前庭癥狀與偏頭痛之間的相互作用，從而提煉出前庭性偏頭痛的基本特征、界定其范圍及共患病的特點(diǎn)，需要對(duì)存在各種前庭癥狀、頭痛、精神癥狀的良好依從性的病人進(jìn)行更多更廣泛的研究。 Vestibular Migraine
COMORBIDITIES IN VESTIBULAR MIGRAINE Scott EGGERS1, Brian NEFF2, Neil SHEPARD3, Jeffrey STAAB4 1Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA 2Department of Otorhinolaryngology,Mayo Clinic, Rochester, Minnesota, USA 3Department of Audiology, Mayo Clinic, Rochester, Minnesota, USA 4Department of Psychiatry And Psychology, Mayo Clinic, Rochester, Minnesota, USA Diagnosing vestibular migraine (VM) currently depends upon symptoms in two dimensions: episodic vestibular symptoms temporally related to migraine symptoms, according to recent consensus criteria. The characteristics of vestibular symptoms and headache that should be required for VM remains unsettled. Insufficient migraine features may prevent diagnosing VM in patients with longstanding episodic vertigo associated with headache who are otherwise identical to those meeting VM criteria. Furthermore, the frequent presence of comorbid conditions introduces a third dimension of diagnostic uncertainty that may confound clinical application and research validation of VM criteria. Several neurotologic conditions whose symptoms overlap with VM occur more frequently in migraineurs than controls, including benign paroxysmal positional vertigo, Ménière’s disease, and motion sickness. VM patients also have high rates of persistent postural-perceptual dizziness (PPPD), which is characterized by chronic (often daily) non-vertiginous dizziness, unsteadiness, and sensitivity to motion. The type and maximal duration of vestibular symptoms attributable to VM versus a separate syndrome like PPPD is a key issue as diagnostic criteria and presumed pathophysiology of VM are refined. Our pharmacologic dissection trial of patients with comorbid VM and PPPD revealed improvement of PPPD-specific symptoms using sertraline, suggesting that chronic vestibular symptoms in patients with VM represent co-existing PPPD, not a chronic form of VM. Broadly inclusive studies of well-characterized patients with wide-ranging vestibular, headache, and psychiatric symptoms are needed to fully understand how vestibular symptoms and migraine interact in order to truly validate vestibular migraine, distill its essential features, define its boundaries, and characterize overlapping comorbidities.
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