| 238 | 0 | 22 |
| 下载次数 | 被引频次 | 阅读次数 |
前庭性偏头痛（vestibular migraine,VM）是一种常见的发作性眩晕疾病，由于其具有异质性，临床表现复杂且常与其他前庭疾病重叠而导致诊断存在困难。本文基于现有的研究，将VM与其他常见前庭疾病的临床症状进行分类，包括表现类似梅尼埃病的VM、类似良性阵发性位置性眩晕的VM和类似持续性姿势-感知性头晕的VM，探讨其可能的发病机制，并与相应前庭疾病鉴别，提供具有针对性的治疗思路。此外，良性复发性眩晕/复发性前庭病与VM关系密切，部分可能为程度较轻的VM。梳理归纳VM的临床类型，有助于提高VM诊断的准确性，并为其精准性治疗提供新的临床思路。
Abstract：Vestibular migraine(VM) is a common episodic vertigo disorder. Due to its heterogeneity, the clinical manifestations are complex and often overlap with other vestibular diseases, leading to difficulties in diagnosis. Based on existing research, this article categorizes the clinical symptoms of VM in comparison to other common vestibular diseases, including Ménière's disease(MD), benign paroxysmal positional vertigo(BPPV) and persistent postural-perceptual dizziness(PPPD). Possible pathogenesis, differentials against other related vestibular diseases and targeted treatment ideas are discussed. Benign recurrent vertigo/recurrent vestibulopathy(BRV/RV) is closely related to VM, possibly representing mild forms of VM in some cases. Classifying the clinical types of VM can help improve the accuracy of VM diagnosis and provide new clinical insights for its precision treatment.
[1]Lempert T,Olesen J,Furman J,et al.Vestibular migraine:diagnostic criteria1[J].J Vestib Res,2022,32(1):1-6.DOI:10.3233/VES-201644.
[2]Li M,Xu X,Qi W,et al.Vestibular migraine:the chameleon in vestibular disease[J].Neurol Sci,2021,42:1719-1731.DOI:10.1007/s10072-021-05133-1.
[3]Mok B,Welgampola MS,Rosengren SM.Vestibular migraine as a mimic of benign paroxysmal positioning vertigo and Meniere's disease[J].J Vestib Res Research,2025,35(1):30-38.DOI:10.3233/VES-240038.
[4]Abouzari M,Goshtasbi K,Moshtaghi O,et al.Association between vestibular migraine and migraine headache:yet to explore[J].Otol Neurotol,2020,41(3):392-396.DOI:10.1097/MAO.0000000000002528.
[5]Teggi R,Colombo B,Cugnata F,et al.Phenotypes and clinical subgroups in vestibular migraine:a cross-sectional study with cluster analysis[J].Neurol Sci,2024,45(3):1209-1216.DOI:10.1007/s10072-023-07116-w.
[6]马艳敏，张道培，张怀亮.前庭性偏头痛分期诊断的研究进展[J].实用医学杂志，2023,39(4):400-403.DOI:10.3969/j.issn.1006-5725.2023.04.002.
[7]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.
[8]Lopez-Escamez JA,Dlugaiczyk J,Jacobs J,et al.Accompanying symptoms overlap during attacks in Meniere’s disease and vestibular migraine[J].Front Neurol,2014,5:265.DOI:10.3389/fneur.2014.00265.
[9]Beh SC,Masrour S,Smith SV,et al.The spectrum of vestibular migraine:clinical features,triggers,and examination findings[J].Headache,2019,59(5):727-740.DOI:10.1111/head.13484.
[10]Shi S,Wang D,Ren T,et al.Auditory manifestations of vestibular migraine[J].Front Neurol,2022,13:944001.DOI:10.3389/fneur.2022.944001.
[11]García A,Madrigal J,Castillo-Bustamante M.Vestibular migraine and tinnitus:a challenging narrative[J].Cureus,2021,13(6):e15998.DOI:10.7759/cureus.15998.
[12]孙素芬，司楠楠，索利敏.前庭性偏头痛发病机制的基因学研究进展[J].中华耳科学杂志，2018,16(3):307-311.DOI:10.3969/j.issn.1672-2922.2018.03.010.
[13]Baloh RW.Vestibular migraine I:mechanisms,diagnosis,and clinical features[J].Semin Neurol,2020,40(1):76-82.DOI:10.1055/s-0039-3402735.
[14]Espinosa-Sanchez JM,Lopez-Escamez JA.New insights into pathophysiology of vestibular migraine[J].Front Neurol,2015,6:12.DOI:10.3389/fneur.2015.00012.
[15]Vass Z,Steyger PS,Hordichok AJ,et al.Capsaicin stimulation of the cochlea and electric stimulation of the trigeminal ganglion mediate vascular permeability in cochlear and vertebro-basilar arteries:a potential cause of inner ear dysfunction in headache[J].Neuroscience,2001,103(1):189-201.DOI:10.1016/s0306-4522(00)00521-2.
[16]Vass Z,Dai CF,Steyger PS,et al.Co-localization of the vanilloid capsaicin receptor and substance P in sensory nerve fibers innervating cochlear and vertebro-basilar arteries[J].Neuroscience,2004,124(4):919-927.DOI:10.1016/j.neuroscience.2003.12.030.
[17]Kirsch V,Boegle R,Gerb J,et al.Imaging endolymphatic space of the inner ear in vestibular migraine[J].J Neurol Neurosurg Psychiatry,2025,96(5):415-423.DOI:10.1136/jnnp-2024-334419.
[18]Silva VPR,Castro LHM,Calderaro M.Vestibular migraine[J].Arq Neuropsiquiatr,2022,80(5 Suppl 1):232-237.DOI:10.1590/0004-282XANP-2022-S111.
[19]孙政涛，刘博，张祎，等.梅尼埃病和前庭性偏头痛的临床特点与相关机制研究进展[J].听力学及言语疾病杂志，2025,33(5):495-501.DOI:10.3969/j.issn.1006-7299.2025.05.017.
[20]史珊珊，江雪梅，潘永惠.前庭性偏头痛发病机制及诊疗的研究进展[J].中国临床神经科学，2020,28(1):104-109.
[21]王雯，方琪.前庭性偏头痛的位置性眼震研究进展[J].中华耳科学杂志，2024,22(1):36-39.DOI:10.3969/j.issn.1672-2922.2024.01.009.
[22]Mahrous MM.Vestibular migraine and benign paroxysmal positional vertigo,close presentation dilemma[J].Acta Otolaryngol,2020,140(9):733-736.DOI:10.1080/00016489.2020.1770857.
[23]王雯，韩淋，方琪.中枢性位置性眼震的研究现状[J].中华医学杂志，2024,104(14):1192-1195.DOI:10.3760/cma.j.cn112137-20240206-00286.
[24]Choi JY,Kim JS.Central positional nystagmus:characteristics and model-based explanations[J].Prog Brain Res,2019,249:211-225.DOI:10.1016/bs.pbr.2019.04.012.
[25]King S,Priesol AJ,Davidi SE,et al.Self-motion perception is sensitized in vestibular migraine:pathophysiologic and clinical implications[J].Sci Rep,2019,9(1):14323.DOI:10.1038/s41598-019-50803-y.
[26]King S,Wang J,Priesol AJ,et al.Central integration of canal and otolith signals is abnormal in vestibular migraine[J].Front Neurol,2014,5:233.DOI:10.3389/fneur.2014.00233.
[27]Lemos J,Strupp M.Central positional nystagmus:an update[J].J Neurol,2022,269(4):1851-1860.DOI:10.1007/s00415-021-10852-8.
[28]Zhang Y,Zhang Y,Tian K,et al.Calcitonin gene-related peptide facilitates sensitization of the vestibular nucleus in a rat model of chronic migraine[J].J Headache Pain,2020,21:1-15.DOI:10.1186/s10194-020-01145-y.
[29]Lorincz D,Drury HR,Lim R,et al.Immunohistochemical identification of sensory neuropeptides Calcitonin Gene-Related Peptide(CGRP),-Substance P and Pituitary Adenylate Cyclase-Activating Polypeptide(PACAP)in efferent vestibular nucleus neurons[J].Neuroendocrinology,2025,115(3-4):269-282.DOI:10.1159/000542984.
[30]Radtke A,Neuhauser H,Von Brevern M,et al.Vestibular migraine--validity of clinical diagnostic criteria[J].Cephalalgia,2011,31(8):906-913.DOI:10.1177/0333102411405228.
[31]Young AS,Nham B,Bradshaw AP,et al.Clinical,oculographic,and vestibular test characteristics of vestibular migraine[J].Cephalalgia,2021,41(10):1039-1052.DOI:10.1007/s00415-021-10699-z.
[32]Zhang S,Liu D,Tian E,et al.Central vestibular dysfunction:don’t forget vestibular rehabilitation[J].Expert Rev Neurother,2022,22(8):669-680.DOI:10.1080/14737175.2022.2106129.
[33]Staab JP,Eckhardt-Henn A,Horii A,et al. Diagnostic criteria for persistent postural-perceptual dizziness(PPPD):consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society[J].J Vestib Res,2017,27(4):191-208.DOI:10.3233/VES-170622.
[34]Hac NEF,Gold DR.Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics[J].Neurotherapeutics,2024,21(4):e00381.DOI:10.1016/j.neurot.2024.e00381.
[35]Molnár A,Maihoub S,Mavrogeni P,et al.Depression scores and quality of life of vertiginous patients,suffering from different vestibular disorders[J].Eur Arch Otorhinolaryngol,2022,279(11):5173-5179.DOI:10.1007/s00405-022-07366-y.
[36]刘俊宏，王理想，马艳敏，等.慢性前庭性偏头痛临床初识[J].中华耳科学杂志，2024,22(1):44-48.DOI:10.3969/j.issn.1672-2922.2024.01.011.
[37]马艳敏，张道培，王伟涛，等.前庭性偏头痛和持续性姿势-感知性头晕的共病机制[J].临床耳鼻咽喉头颈外科杂志，2022,36(4):321-324.DOI:10.13201/j.issn.2096-7993.2022.04.018.
[38]Zhe X,Gao J,Chen L,et al.Altered structure of the vestibular cortex in patients with vestibular migraine[J].Brain Behav,2020,10(4):e01572.DOI:10.1002/brb3.1572.
[39]Li P,Gu H,Xu J,et al.Purkinje cells of vestibulocerebellum play an important role in acute vestibular migraine[J].J Integr Neurosci,2019,18(4):409-414.DOI:10.31083/j.jin.2019.04.1168.
[40]Chen CH,Newman LN,Stark AP,et al.A Purkinje cell to parabrachial nucleus pathway enables broad cerebellar influence over the forebrain[J].Nat Neurosci,2023,26(11):1929-1941.DOI:10.1038/s41593-023-01462-w.
[41]Ma YM,Zhang DP,Zhang HL,et al.Why is vestibular migraine associated with many comorbidities?[J].J Neurol,2024,271(12):7422-7433.DOI:10.1007/s00415-024-12692-8.
[42]Zou X,He J,Zhou M,et al.Photophobia and visual triggers in vestibular migraine[J].Neurol Ther,2024,13(4):1191-1201.DOI:10.1007/s40120-024-00631-8.
[43]Cao ZM,Chen YC,Liu GY,et al.Abnormalities of thalamic functional connectivity in patients with migraine:a resting-state fMRI study[J].Pain Ther,2022,11(2):561-574.DOI:10.1007/s40122-022-00365-1.
[44]Noseda R,Kainz V,Jakubowski M,et al.A neural mechanism for exacerbation of headache by light[J].Nat Neurosci,2010,13(2):239-245.DOI:10.1038/nn.2475.
[45]Okamoto K,Tashiro A,Chang Z,et al.Bright light activates a trigeminal nociceptive pathway[J].Pain,2010,149(2):235-242.DOI:10.1016/j.pain.2010.02.004.
[46]Goadsby PJ,Holland PR,Martins-Oliveira M,et al.Pathophysiology of migraine:a disorder of sensory processing[J].Physiol Rev,2017,97(2):553-622.DOI:10.1152/physrev.00034.2015.
[47]Li ZY,Si LH,Shen B,et al.Altered brain network functional connectivity patterns in patients with vestibular migraine diagnosed according to the diagnostic criteria of the Bárány Society and the International Headache Society[J].J Neurol,2022,269(6):3026-3036.DOI:10.1007/s00415-021-10868-0.
[48]明娟娟.前庭性偏头痛的眼震视图表现及诊断价值[D].十堰：湖北医药学院，2024.DOI:10.27913/d.cnki.ghyby.2024.000237.
[49]Slater R.Benign recurrent vertigo[J].J Neurol Neurosurg Psychiatry,1979,42(4):363-367.DOI:10.1136/jnnp.42.4.363.
[50]Leliever WC,Barber HO.Recurrent vestibulopathy[J].Laryngoscope,1981,91(1):1-6.DOI:10.1288/00005537-198101000-00001.
[51]Dlugaiczyk J,Lempert T,Lopez-Escamez JA,et al.Recurrent vestibular symptoms not otherwise specified:clinicalcharacteristics compared with vestibular migraine and Meniere's disease[J].Front Neurol,2021,12:674092.DOI:10.3389/fneur.2021.674092.
[52]Kaçan M,KirazlıG,Balayeva F,et al.Recurrent vestibulopathy:-comparison of vestibular test results with Meniere's disease and vestibular migraine[J].Audiol Neurootol,2023,28(2):116-127.DOI:10.1159/000526814.
[53]Pan Q,Zhang Y,Zhang S,et al.Clinical features andoutcomes of benign recurrent vertigo:a longitudinal study[J].Acta Neurol Scand,2020,141(5):374-379.DOI:10.1111/ane.13214.
[54]Teggi R,Colombo B,Cangiano I,et al.Similarities and differences between vestibular migraine and recurrent vestibular symptoms—Not Otherwise Specified(RVS-NOS)[J].Audiol Res,2023,13(3):466-472.DOI:10.3390/audiolres13030041.
基本信息:
中图分类号:R764
引用信息:
[1]黄一帆,张永辉,王伟涛,等.前庭性偏头痛的临床类型及其机制[J].中华耳科学杂志,2026,24(04):368-373.
基金信息:
国家自然科学基金项目（82575006）; 河南省中医药科学研究专项课题（2024ZY1008）
2026-04-09
2026-04-09