慢性緊縮型頭痛患者之頭暈或眩暈

The Dizziness or Vertigo of Chronic Tension-type Headache

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen) ； 湯耀貿(Yao-Mao Tang)

《童綜合醫學雜誌》 5卷2期 (2011/12) Pp. 66-72

https://doi.org/10.29838/TMJ.201112.0004

摘要

背景及目的：慢性緊縮型頭痛臨床上並不多見，部分慢性緊縮型頭痛患者會合併頭暈或眩暈，特回顧近3年內我們所遇之案例，並分享我們的診治經驗。方法：回溯2008年至2010年間，診斷為慢性緊縮型頭痛，合併頭暈或眩暈，並已以磁振造影排除器質性病變之患者。他們會有完整的理學檢查、血液學檢查、神經耳科學檢查及整體腦血流量測量。神經耳科學檢查包括純音聽力檢查、眼振電圖、兩耳溫差測試及氣導震動式頸性前庭誘發肌性電位檢查。結果：共6名患者（男4，女2），平均57.5歲。僅1名為左側後半規管之耳石沉著症，2名為上前庭神經路徑功能障礙，2名為腦幹之前庭神經核功能障礙，1名雖無法確認是否合併週邊性前庭功能障礙，但至少應有兩側中樞性前庭功能障礙。治療均以保守性複合療法為主。無人在慢性緊縮型頭痛消失後，仍苦於頭暈或眩暈。結論：週邊性前庭功能障礙與中樞性前庭功能障礙各佔一半，可以適度地使用抗眩暈藥。只要頭痛消失，頭暈或眩暈也會跟著消失。

關鍵字

慢性緊縮性頭痛 ； 良性陣發性姿態性眩暈症 ； 前庭神經病變 ； 中樞性前庭功能障礙

並列摘要

Background and purpose: Chronic tension-type headache (CTTH) is clinically uncommon. Some sufferers also have dizziness or vertigo. We reviewed the cases we met in recent three years, and shared our experience.Methods: We collected the patients who were diagnosed with CTTH accompanied with dizziness or vertigo, and all the patients had normal magnetic resonance images between 2008 and 2010. Physical examinations, blood examinations, neuro-otologic studies and total cerebral blood flow measurements were performed. The neuro-otologic studies included pure tone audiometry, electronystagmogram, caloric test and air-conducted vibration cervical vestibular evoked myogenic potential.Results: Six patients were enrolled, including four men and two women. Their age was averaged 57.5 years old. Among them, only one was diagnosed with left posterior semicircular canalolithiasis; two, impairment of superior vestibular pathway; two, impairment of vestibular nucleus in brainstem; and one, bilateral central vestibular dysfunction with possible peripheral vestibular dysfunction. They were treated with combined medication. After the CTTH subsided, patients were not bothered with dizziness or vertigo.Conclusions: Peripheral vestibulopathy is responsible for half of them, and central vestibulopathy for the other half, so anti-vertigo could be deliberatively recommended. As the headache remits, the dizziness or vertigo would remit simultaneously.

並列關鍵字

chronic tension-type headache ； benign paroxysmal positional vertigo ； vestibular neuropathy ； central vestibulopathy