可能為偏頭痛前驅症狀之頭暈

Dizziness as a Possible Premonitory Symptom of Migraine

頭暈或眩暈在預兆偏頭痛患者會比無預兆偏頭痛患者常見，常常會超過1小時，因此，是否也是預兆尚具爭議，但常會出現在偏頭痛的前驅症狀與緩解症狀。一25歲男性，這1年來反覆發作頭暈與不平衡，合併噁心、單側嘴角感覺異常、面部及頸部肌肉僵硬，鑒於第4次發作時，頭暈及不平衡感已持續3週，遂求診於本院。耳鼻喉理學檢查、前庭功能檢查、純音聽力檢查、心電圖及醒覺腦波圖均無異常發現，但是，視運動性後眼振及兩耳溫差測試呈現異常，兩側前庭誘發肌性電位檢查呈現P13及N23潛值延遲，腦部血管磁振造影呈現後顱窩循環之分支變異，尚無腦部異常。該次病症在保守治療後2週消失，但在1個月後又發作了一次，病症僅1日。鑒於其父母均罹患偏頭痛，本個案反覆發作的頭暈可能就是偏頭痛的前驅症狀，只是尚未演變成預兆或偏頭痛，但易造成小腦或腦幹的傷害，引起頭暈或不平衡，尚需密切的追蹤，爾後可能會演變成偏頭痛。

Dizziness or vertigo is a common premonitory or postdromal symptom of migraine and more common in patients who have migraine with aura than in patients who have migraine without aura. Because dizziness is often prolonged (more than one hour), the notion that dizziness is due to aura is controversial. A 25-year-old male had several attacks of dizziness and unsteadiness. Nausea, paresthesia along one side of the mouth, and unilateral facial and nuchal muscle stiffness were also noted. Because the fourth attack of dizziness and unsteadiness persisted three weeks, he visited our hospital for help. The results of his otolaryngologic physical examination, vestibular function test, pure tone audiometry, electrocardiogram, and awake electroencephalogram were normal, but those of his bilateral optokinetic after nystagmus test and Caloric test were not. Bilateral vestibular evoked myogenic potential results showed prolonged P13 and N23 latencies. Magnetic resonance angiogram of the brain revealed insufficient blood flow in branches of the posterior circulation and no brain lesion. Then, the patient became asymptomatic after two weeks of conservative treatment. However, episodes of the disease subsequently recurred once a month for 24 hours. Both of his parents suffered migraines, suggesting that his frequent attacks of dizziness might be predictive of migraine. However, neither aura nor migraine developed. Possibly, impairment of the cerebellum and brainstem led to paroxysms that caused imbalance and dizziness. He should be followed regularly since he is certain to suffer migraine in the future.