肢体疼痛可能是偏头痛时未被识别的表现


  【24drs.com】一篇新研究认为,虽然肢体疼痛未被纳入国际头痛分类的偏头痛表现,儿童和成人在偏头痛时,可能会发生周期性肢体疼痛。对家庭四代成员的研究指出肢体疼痛和偏头痛的家族形式。
  
  英国与智利的联合研究中,研究者进行了前瞻性临床及家谱分析,对象是27名家族成员、追踪8年,他们定义偏头痛肢体疼痛为:在偏头痛发作、丛集性头痛或丛集性偏头痛时,间歇性的手臂或腿部疼痛,没有其它解释,但也可能发生在没有头痛时。家谱分析显示,体染色体显性遗传表现,在孩童主要是肢体痛,成年人是偏头痛。
  
  英国伦敦大学院资深讲师、皇家自由医院神经科顾问、皇家医学会临床神经科学前任会长Heather Angus-Leppan医师表示,这在成年人常见,类型为偏瘫型偏头痛,至于在孩童,三分之一孩童有一定的周期性症状,如与他们的偏头痛有关的肢体疼痛。
  
  Angus-Leppan医师在第22届神经内科世界大会(World Congress of Neurology,WCN)发表研究结果。
  
  27个家族成员中,有8个人曾有良性复发性肢体和/或全身疼痛;最早在8岁就曾发生疼痛、最晚是30岁时,在5-52年间复发。疼痛部位包括:手臂、手、肩膀、胸与颈。肢体疼痛是单侧的,但是在每次发作时可能会在不同侧发生。肢体疼痛前、中、后发生头痛(8个人中有7人有某种形式的先兆),成年人的肢体疼痛可能在没有头痛时发生。
  
  这个状况的发生程度可能随著年龄而改变,孩童通常有肢体疼痛而没有头痛。Angus-Leppan医师表示,孩童的肢体疼痛很像那些发生偏头痛的人,令人脸色发青,他们往往无法活动,然后慢慢恢复。对于许多孩童而言,随著年纪增加,发作频率会降低,但是可能会发生偏头痛性头痛或其它症状。
  
  年长者可能会有不太严重的头痛和比较多的视觉先兆。因此,她表示,充分了解家族史,以便能够为偏头痛症状进行适当分类是很重要的,这将有助于治疗。
  
  Angus-Leppan 医师强调,对于避免不必要的检查和让患者接受适当治疗,确认偏头痛时的肢体疼痛是很重要的。
  
  在成年人,肢体疼痛的偏头痛原因通常被误认为神经受压、神经根病变、胸廓出口症候群、慢性疲劳症候群、功能性症状、关节炎。在孩童,可能被误认为成长痛、骨或关节病变、不想上学。
  
  一旦确认,Angus-Leppan医师表示,这个症状相当有助于急性治疗和预防偏头痛,它的原理和其它偏头痛的表现一样。
  
  会议主持人、英国皇家医学会临床神经科学部前任理事长、伦敦帝国学院荣誉资深讲师Russell Lane医师发表评论时指出,这篇大型且有充分家族特征的研究提出的问题是,是否这是单一基因突变或者复杂的突变确定此特定表现型。
  
  在诊断方面,他表示,如果肢体疼痛发生在明确发作的偏头痛时,它显然是有所关联。但是,我的印象是,有时患者不会提到肢体疼痛或其它躯体疼痛表现。
  
  Lane医师表示,偏头痛发作时的其它疼痛可能包括假性心绞痛与头痛,病患可能会因为被怀疑有冠状动脉血栓形成而住进加护病房。
  
  他表示,幼童也可能会有腹痛,经常被怀疑患有阑尾炎,许多孩童可能因此被切除阑尾,事实上,他们一直有相当于偏头痛的情况。这可能造成有相当高比率的正常阑尾被切除。
  
  Lane医师表示,偏头痛可能会出现其它不寻常的症状,例如雷诺氏现象(Reynaud's phenomenon)和晕厥,这些情况反应出较引人注目的钙拮抗剂。所以,良好的病史可以发现这类情况,引导进行有效的疗法,并且避免不必要的检测、转诊、误诊、延误诊断和痛苦。
  
  资料来源:http://www.24drs.com/
  
  Native link:Limb Pain May Be Unrecognized Manifestation of Migraine
  

Limb Pain May Be Unrecognized Manifestation of Migraine

By Daniel M. Keller, PhD
Medscape Medical News

SANTIAGO, Chile — Although limb pain is not included as a manifestation of migraine in international headache classifications, children and adults may experience recurrent limb pain as part of the migraine spectrum, a new study suggests. The four-generation study reveals a familial form of limb pain and migraine.

In the joint British-Chilean study, researchers performed a prospective clinical and pedigree analysis involving a 27-member family followed for 8 years. They defined migraine limb pain as intermittent arm or leg pain during a migraine episode, cluster headache, or cluster migraine with no other explanation but that may also occur in the absence of headache. The pedigree analysis showed an autosomal dominant inheritance pattern manifesting mainly as limb pain in children and as migraine in adults.

"It's common in adults. It's as common as hemiplegic migraine, and in children, one third of children will have some periodic syndrome like limb pain associated with their migraines," Heather Angus-Leppan, MD, MSc, consultant neurologist at the Royal Free Hospital and senior lecturer at University College London, United Kingdom, and immediate past president of clinical neurosciences at the Royal Society of Medicine, told Medscape Medical News.

She presented her results here at the XXII World Congress of Neurology (WCN).

Eight of the 27 members of the family had benign recurrent limb and/or body pain. Pain began as early as age 8 years and as late as age 30, and it recurred over 5 to 52 years. Sites of pain were the arm, hand, shoulder, chest, and neck. Limb pain was unilateral but could vary sides from episode to episode. Headache (7 of 8 members with some form of aura) occurred before, during, or after limb pain, and limb pain in adults could occur without headache.

The spectrum of manifestations of the condition may change over the lifetime. Children frequently have limb pain without headache. "The limb pain in children acts like migraine in that the person is often pale with it, they often withdraw from activity, and then they get completely better," Dr Angus-Leppan said. For many children, episodes become less frequent as they age, but migraine headache or other manifestations may develop.

Elderly people may have less severe headache and more visual aura. Therefore, she says, taking a good history is important to be able to categorize symptoms as part of a migraine syndrome, which can lead to effective treatment.

Limb Pain With Migraine Amenable to Treatment

Dr Angus-Leppan emphasized that recognition of limb pain in migraine is important for preventing unnecessary investigations and getting people on appropriate treatments.

In adults, a migrainous cause of limb pain may be mistaken for nerve entrapment, radiculopathy, thoracic outlet syndrome, chronic fatigue syndrome, functional symptoms, or arthritis. In children, possible red herrings are growing pains, bone or joint pathology, and school avoidance.

Once recognized, "this syndrome responds very well to acute treatment and to migraine prophylaxis," Dr Angus-Leppan said. "It works as well as in other migraine manifestations."

Session moderator Russell Lane, MD, honorary senior lecturer at Imperial College London and past president of the section of clinical neurosciences of the Royal Society of Medicine in the United Kingdom, commented to Medscape Medical News that the study of this large and well-characterized family raises the question of whether "this a single gene mutation or complex of mutations which determines this particular phenotype."

In terms of diagnosis, he said that if the limb pain occurs in a clear-cut attack of migraine, it should be fairly obvious to make the connection. "But my impression is that sometimes patients don't mention limb pain or other somatic pain manifestations," he said.

Other pains on a migraine spectrum may include pseudoangina with headache, and patients may end up in the intensive care unit for suspected coronary thrombosis, Dr Lane said.

Young children also may have abdominal pain and often are suspected of having appendicitis, "and many children will have had their appendices removed, and in fact, they've been having a migrainous equivalent," probably accounting for a considerable proportion of normal appendices being removed, he cautioned.

Dr Lane said migraine may present with other unusual symptoms, such as Reynaud's phenomenon and syncope, and these cases respond "rather spectacularly to calcium antagonists." So a good medical history may reveal such cases and lead to very effective therapy, as well as avoid unnecessary testing, referrals, misdiagnosis, delayed diagnosis, and suffering.

The study was funded by the National Fund for Scientific and Technological Development of the Government of Chile. Dr Angus-Leppan and Dr Lane have disclosed no relevant financial relationships.

XXII World Congress of Neurology (WNC). Abstract 180. Presented November 1, 2015.

    
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