Comparative study on the clinical features of familial clustered and sporadic vestibular migraine
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摘要: 目的 比较分析家族聚集性前庭性偏头痛(FCVM)与散发性前庭性偏头痛(SVM)患者的临床特征。方法 选取118例前庭性偏头痛患者, 根据有无家族聚集性发病分为FCVM组(66例)和SVM组(52例), 分析比较两组患者的发病年龄、症状形式、影响因素、听力学症状、发作后遗症及合并症。结果 FCVM组患者的头痛发病年龄较SVM组早[分别为(23.88±11.45)岁和(28.77±11.85)岁, χ2=2.267, P=0.025], 间隔时间较长[分别为(13.11±10.08)岁和(8.50±9.26)岁, χ2=2.554, P=0.012]。FCVM组表现位置性眩晕患者较SVM多[分别为12例(18.2%)和0(0), χ2=3.171, P=0.002]。相比于SVM患者, 精神焦虑(P < 0.001)、颈部僵直(P=0.028)及注意力难以集中(P=0.001)在FCVM患者发作后期更为多见。FCVM组合并原发性晕动病患者多于SVM组[分别为49例(74.2%)和25例(48.1%), χ2=2.906, P=0.004]。结论 FCVM患者的发病年龄较早, 多预后不良。原发性晕动病可作为FCVM早期诊断的参考指标。Abstract: Objective To compare and analyze the clinical features of family clustered vestibular migraine(FCVM) and sporadic vestibular migraine(SVM).Methods A total of 118 patients with vestibular migraine were selected and divided into FCVM group(66 cases) and SVM group(52 cases), and the clinical features such as age, the form of symptoms, provoking and relieving factors, audiological manifestations, sequelae and complications, were compared and analyzed.Results The onset of headache in FCVM group was earlier than that in SVM group ([23.88±11.45] years old and [28.77±11.85] years old, χ2=2.267, P=0.025) with a longer interval between headache and vertigo attack ([13.11±10.08] years old and [8.50±9.26] years old, χ2=2.554, P=0.012).Patients with positional vertigo in the FCVM group were more than those in the SVM group (12[18.2%] and 0[0], χ2=3.171, P=0.002). Mental anxiety(P < 0.001), neck stiffness(P=0.028), and concentration difficulties(P=0.001) were more common in patients with FCVM at the end of the episode than in patients with SVM. Comorbid primary motion sickness combined was more common in FCVM group than in SVM group(49 cases[74.2%] and 25 cases[48.1%], χ2=2.906, P=0.004).Conclusion The onset of FCVM is earlier and the prognosis is often poor. Primary motion sickness can be used as a reference for the early diagnosis of FCVM.
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Key words:
- vestibular migraine /
- family clustered /
- clinical features /
- motion sickness
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表 1 VM的一般临床资料
项目 FCVM组(66例) SVM组(52例) t P 性别/例(%) 0.199 0.656 女 53(80.30) 40(76.92) 男 13(19.70) 12(23.08) 复诊/例(%) 46(69.70) 38(73.08) 0.749 0.454 年龄/岁 入组年龄 42.05±9.72(14~57) 44.33±11.08(21~59) 1.189 0.237 头痛发病年龄 23.88±11.45(5~48) 28.77±11.85(6~50) 2.267 0.025 眩晕发病年龄 36.94±8.34(14~53) 38.08±9.10(19~54) 0.707 0.481 间隔时间/年 13.11±10.08(0~34) 8.50±9.26(0~35) 2.554 0.012 
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表 2 VM患者的临床特征
例(%) 项目 FCVM组(66例) SVM组(52例) t P 头痛分型 先兆性 16(24.2) 10(19.2) 0.540 0.589 非先兆性 50(75.8) 42(80.8) 1.081 0.280 受累部位 颞部 43(65.2) 29(55.8) 0.783 0.434 枕部 6(9.1) 6(11.5) 0.507 0.612 额部 4(6.1) 4(7.7) 0.406 0.684 顶部 2(3.0) 3(5.8) 0.777 0.437 不确定 11(16.7) 10(19.2) 0.460 0.646 眩晕分型 自发性眩晕 35(53.0) 32(61.5) 1.398 0.162 位置性眩晕 12(18.2) 0(0) 3.171 0.002 视觉诱导性眩晕 10(15.2) 15(28.8) 2.145 0.032 头位诱导性眩晕 5(7.6) 5(9.6) 0.459 0.646 头位诱导性头晕伴恶心 4(6.1) 0(0) 1.764 0.078 眩晕持续时间/h < 2 13(19.7) 14(26.9) 1.043 0.297 2~12 9(13.6) 5(9.6) 0.593 0.553 13~24 7(10.6) 10(19.2) 1.411 0.158 25~72 18(27.3) 11(21.2) 0.647 0.518 >72 19(28.8) 12(23.1) 0.575 0.566 头痛与眩晕发作关系 独立发作 41(62.1) 31(59.6) 0.013 0.989 同时发作 13(19.7) 11(21.2) 0.302 0.763 头痛先于眩晕发作 5(7.6) 4(7.7) 0.084 0.933 眩晕先于头痛发作 7(10.6) 6(11.5) 0.235 0.814
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表 3 VM的影响因素、听力学改变及后遗症状
例(%) 项目 FCVM组(66例) SVM组(52例) t P 诱发/加重因素 劳累 47(71.2) 32(61.5) 1.104 0.269 噪声 45(68.2) 30(57.7) 1.170 0.242 强光 33(50.0) 23(44.2) 0.620 0.535 压力 32(48.5) 21(40.4) 0.875 0.382 活动 31(47.0) 20(38.5) 0.922 0.356 熬夜 29(43.9) 18(34.6) 1.023 0.306 着凉 15(22.7) 7(13.5) 1.278 0.201 异味 12(18.2) 6(11.5) 0.992 0.321 生理期 10(15.2) 3(5.8) 1.609 0.108 天气 10(15.2) 3(5.8) 1.609 0.108 听力学改变 听力下降 15(22.7) 8(15.4) 0.995 0.320 耳鸣 30(45.5) 29(55.8) 1.108 0.268 耳闷 12(18.2) 5(9.6) 1.310 0.190 后遗症状 头昏/头胀 52(78.8) 41(78.8) 0.008 0.994 精神焦虑 34(51.5) 19(36.5) 3.817 < 0.001 颈部僵直 28(42.4) 22(42.3) 2.195 0.028 注意力难以集中 25(37.9) 16(30.8) 3.214 0.001
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表 4 VM的听力学改变及合并症
例(%) 项目 FCVM组(66例) SVM组(52例) t P 合并内耳疾病 BPPV 11(16.7) 16(30.8) 1.803 0.071 MD 2(3.0) 2(3.8) 0.242 0.809 合并晕动病 原发性 49(74.2) 25(48.1) 2.906 0.004 继发性 5(7.6) 7(13.5) 1.046 0.296
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[1] Van Ombergen A, Van Rompaey V, Van de Heyning P, et al. Vestibular migraine in an otolaryngology clinic: prevalence, associated symptoms, and prophylactic medication effectiveness[J]. Otol Neurotol, 2015, 36(1): 133-138. doi: 10.1097/MAO.0000000000000596
[2] Lempert T, Neuhauser H. Epidemiology of vertigo, migraine and vestibular migraine[J]. J Neurol, 2009, 256(3): 333-338. doi: 10.1007/s00415-009-0149-2
[3] Dieterich M, Obermann M, Celebisoy N. Vestibular migraine: the most frequent entity of episodic vertigo[J]. J Neurol, 2016, 263 Suppl 1: S82-S89.
[4] 段付军, 徐先荣, 张丹, 等. 前庭性偏头痛的临床特征分析[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(8): 726-730. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202008011.htm
[5] Teggi R, Colombo B, Albera R, et al. Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects[J]. Headache, 2018, 58(4): 534-544. doi: 10.1111/head.13240
[6] Headache Classification Committee of the International Headache Society(IHS)The International Classification of Headache Disorders, 3rd edition[J]. Cephalalgia, 2018, 38(1): 1-211.
[7] van de Berg R, Widdershoven J, Bisdorff A, et al. Vestibular Migraine of Childhood and Recurrent Vertigo of Childhood: Diagnostic criteria Consensus document of the Committee for the Classification of Vestibular Disorders of the Bárány Society and the International Headache Society[J]. J Vestib Res, 2021, 31(1): 1-9. doi: 10.3233/VES-200003
[8] Furman JM, Balaban CD. Vestibular migraine[J]. Ann N Y Acad Sci, 2015, 1343: 90-96. doi: 10.1111/nyas.12645
[9] 曹鹏禹, 刘红巾, 徐先荣, 等. 门诊主诉"眩晕或头晕"患者病因分层分析[J]. 听力学及言语疾病杂志, 2020, 28(6): 631-635. doi: 10.3969/j.issn.1006-7299.2020.06.005
[10] Paz-Tamayo A, Perez-Carpena P, Lopez-Escamez JA. Systematic Review of Prevalence Studies and Familial Aggregation in Vestibular Migraine[J]. Front Genet, 2020, 11: 954. doi: 10.3389/fgene.2020.00954
[11] Lampl C, Rapoport A, Levin M, et al. Migraine and episodic Vertigo: a cohort survey study of their relationship[J]. J Headache Pain, 2019, 20(1): 33. doi: 10.1186/s10194-019-0991-2
[12] 冯慧敏, 金占国, 刘红巾. 前庭性偏头痛相关基因的研究进展[J]. 空军医学杂志, 2020, 36(2): 176-179. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZY202002025.htm
[13] Xue J, Ma X, Lin Y, et al. Audiological Findings in Patients with Vestibular Migraine and Migraine: History of Migraine May Be a Cause of Low-Tone Sudden Sensorineural Hearing Loss[J]. Audiol Neurootol, 2020, 25(4): 209-214. doi: 10.1159/000506147
[14] Lopez-Escamez JA, Carey J, Chung WH, et al. Diagnostic criteria for Menière's disease[J]. J Vestib Res, 2015, 25(1): 1-7. doi: 10.3233/VES-150549
[15] 陈元星, 孙悍军, 张清华, 等. 梅尼埃病与前庭性偏头痛共病患者的临床特点[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(9): 820-823. https://www.cnki.com.cn/Article/CJFDTOTAL-LCEH202009012.htm
[16] Basura GJ, Adams ME, Monfared A, et al. Clinical Practice Guideline: Ménière's Disease[J]. Otolaryngol Head Neck Surg, 2020, 162(2_suppl): S1-S55. doi: 10.1177/0194599820909438
[17] Mahrous MM. Vestibular migraine and benign paroxysmal positional vertigo, close presentation dilemma[J]. Acta Otolaryngol, 2020, 140(9): 741-744. doi: 10.1080/00016489.2020.1766699
[18] Huang TC, Wang SJ, Kheradmand A. Vestibular migraine: An update on current understanding and future directions[J]. Cephalalgia, 2020, 40(1): 107-121. doi: 10.1177/0333102419869317
[19] Jen JC, Baloh RW. Familial episodic ataxia: a model for migrainous vertigo[J]. Ann N Y Acad Sci, 2009, 1164: 252-256. doi: 10.1111/j.1749-6632.2008.03723.x
[20] Abouzari M, Cheung D, Pham T, et al. The Relationship Between Vestibular Migraine and Motion Sickness Susceptibility[J]. Otol Neurotol, 2020, 41(8): 1116-1121. doi: 10.1097/MAO.0000000000002705
[21] Lee SH, Jeong SH, Kim JS, et al. Effect of Prophylactic Medication on Associated Dizziness and Motion Sickness in Migraine[J]. Otol Neurotol, 2018, 39(1): e45-e51. doi: 10.1097/MAO.0000000000001628
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