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Title: [Analysis of clinical features of vestibular migraine].
Author: Duan F, Xu X, Zhang D, Li S, Jin Z, Zhang Y.
Journal: Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi; 2020 Aug; 34(8):726-730. PubMed ID: 32842206.
Abstract:
Objective:To analyze the clinical features of Vestibular migraine（VM） and provide evidence for its accurate diagnosis and medical identification of flight personnel. Method:A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo（BPPV）, and 11 samples were co-occurring with Meniere's disease（MD）. All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months. Result:①The male-female ratio of VM patients was 1∶1.95, the average age was （50.2±14.3） years old, （48.7±15.0） years old for males and （51.0±13.9） years old for females. No statistically significant differences were found（P>0.05）. The average duration was（54.5±84.8） months, （35.0±59.0） months for males and（64.7±94.0） months for females. The difference was statistically significant（P<0.05）. ②The main clinical symptoms are dizziness, migraine or previous history of migraine, fear of sound/noisy environment sensitivity, photophobia/visual sensitivity, nausea/vomiting, vestibular posture symptoms, tinnitus, hearing loss, etc. , diarrhea during dizziness or headache was one special symptom of VM; ③The abnormal rate of vestibular autorotation test（VAT） in 118 VM patients was 72.3%, while the abnormal rate of caloric test in 170 VM patients was 32.9%; ④The effective remission rate within 6 months of VM patients with secondary BPPV and MD was 78.6% and 83.4%, while the VM patients without secondary benign paroxysmal positional vertigo（BPPV） and Meniere's disease（MD） was 93.3%. The difference was statistically significant（P<0.05）. Conclusion:The clinical manifestations of VM patients were various. Female VM patients had higher incidence, the course of disease than male VM patients, diarrhea can be regarded as one of the clinical features distinguished from MD. The abnormal rate of VAT was higher in the common clinical examiniations of VM patients. VM patients treatment should focus on personalized prescription and lifestyle management, vestibular rehabilitation, and corresponding treatment at the same time should be given to patients with secondary BPPV and MD to improve the efficacy. The medical identification of flight personnel VM patients should be strictly controlled, pilots should be grounded, while flight combat personnel and flight technical personnel need chartered medical identification. 目的：分析前庭性偏头痛（VM）的临床特征，为其精准诊治及飞行人员航空医学鉴定提供参考依据。 方法：选取VM患者490例，其中88例继发良性阵发性位置性眩晕（BPPV），11例并发梅尼埃病（MD）。给予药物（丙戊酸、氟桂利嗪、倍他司汀或银杏叶提取物、乌灵胶囊、天麻素、苦碟子等选择2～4种药组方）、生活方式管理及前庭康复等综合治疗，统计其临床特征及6个月内的治疗效果。 结果：①VM患者男女比例为1∶1.95，平均年龄（50.2±14.3）岁，男性为（48.7±15.0）岁，女性为（51.0±13.9）岁，男女平均年龄差异无统计学意义（P>0.05）；平均病程为（54.5±84.8）个月，男性为（35.0±59.0）个月，女性为（64.7±94.0）个月，男女平均病程差异有统计学意义（P<0.05）；②主要临床症状为眩晕、头晕、偏头痛或既往偏头痛病史、畏光/视觉敏感、畏声/嘈杂环境敏感、恶心/呕吐、前庭姿势症状、耳鸣、听力下降等，特殊临床症状为在眩晕或头痛时有腹泻或强烈便意；③118例VM患者的前庭自旋转试验（VAT）的异常率为72.3%，170例VM患者的冷热（气）试验异常率为32.9%；④继发BPPV、并发MD的VM患者6个月的治疗总有效率分别为78.6%和83.4%，低于单纯VM患者的总有效率（93.3%），差异有统计学意义（P<0.05）。 结论：VM患者临床表现多样，女性发病率高、病程长，腹泻或强烈便意可作为与MD鉴别的临床特征之一。VM患者常用的临床检查中VAT异常率较高。VM患者的治疗应注重个性化的组方、生活方式管理及前庭康复的综合应用，对继发BPPV或并发MD的患者应同时给予相应治疗以提高疗效。飞行人员VM的航空医学鉴定从严掌握，飞行员原则上应做停飞处理，空中战勤人员和技勤人员可进行特许医学鉴定。.

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