可能有偏頭痛性眩暈之慢性緊縮型頭痛

Chronic Tension-Type Headache with Probable Migrainous Vertigo

陳建志(Jiann-Jy Chen) ； 莊毓民(Yu-Ming Chuang) ； 孫盛義(Sheng-Yih Sun) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 6卷3期 (2009/06) Pp. 208-214

https://doi.org/10.6200/TCMJ.2009.6.3.06

摘要

緊縮型頭痛目前病因不明，與偏頭痛間可能有類似的致病機轉，兩者均會出現頭暈或眩暈。一47歲男性，有第2型糖尿病、脂肪肝及高血脂症之過去病史，無高血壓、心臟病、偏頭痛或精神病，因反覆頭暈、眩暈及頭痛發作2個月求診於本院。理學檢查、聽力檢查、眼振圖及前庭肌性誘發電位顯示右側前庭功能較強，應有中樞性前庭神經元之功能障礙。血管磁振造顯示前後威利氏環不完整。可能是頭痛發作時，姿態變化引起後顱窩循環瞬間血流不穩，影響到中樞性前庭神經元，造成陣發性眩暈。本個案診斷為慢性緊縮型頭痛，但有頭暈預兆，可能有偏頭痛性眩暈。經保守治療4個月後，病症消失。追蹤迄今5個月，情況依然穩定。

關鍵字

緊縮型頭痛 ； 頭暈預兆 ； 偏頭痛性眩暈

並列摘要

Tension-type headache (TTH) is yet of unknown etiology, and might have the similar mechanism as migraine. Both of TTH and migraine may present dizziness or vertigo. A 47-year-old male had past histories of type 2 diabetes mellitus, fatty liver and hyperlipidemia instead of hypertension, heart disease, migraine or psychiatrics. He has been bothered with recurrent dizziness, vertigo and headache for 2 months. Physical examination, audiometry, electronystagmogram and vestibular evoked myogenic potential showed right stronger vestibular function than left, and central vestibulopathy was impressed. Magnetic resonance angiogram revealed defects of anterior and posterior circle of Willis. It is probable that postural change induced transient posterior circulation insufficiency, then influenced the central vestibular nucleus, and led to episodic vertigo. Finally, chronic TTH with dizzy aura and probable migrainous vertigo was diagnosed. The disease subsided 4 months after he has been treated conservatively. In the following 5 months, it was uneventful.

並列關鍵字

tension-type headache ； dizzy aura ； migrainous vertigo