肢體疼痛可能是偏頭痛時未被識別的表現


  【24drs.com】一篇新研究認為,雖然肢體疼痛未被納入國際頭痛分類的偏頭痛表現,兒童和成人在偏頭痛時,可能會發生週期性肢體疼痛。對家庭四代成員的研究指出肢體疼痛和偏頭痛的家族形式。
  
  英國與智利的聯合研究中,研究者進行了前瞻性臨床及家譜分析,對象是27名家族成員、追蹤8年,他們定義偏頭痛肢體疼痛為:在偏頭痛發作、叢集性頭痛或叢集性偏頭痛時,間歇性的手臂或腿部疼痛,沒有其他解釋,但也可能發生在沒有頭痛時。家譜分析顯示,體染色體顯性遺傳表現,在孩童主要是肢體痛,成年人是偏頭痛。
  
  英國倫敦大學院資深講師、皇家自由醫院神經科顧問、皇家醫學會臨床神經科學前任會長Heather Angus-Leppan醫師表示,這在成年人常見,類型為偏癱型偏頭痛,至於在孩童,三分之一孩童有一定的週期性症狀,如與他們的偏頭痛有關的肢體疼痛。
  
  Angus-Leppan醫師在第22屆神經內科世界大會(World Congress of Neurology,WCN)發表研究結果。
  
  27個家族成員中,有8個人曾有良性復發性肢體和/或全身疼痛;最早在8歲就曾發生疼痛、最晚是30歲時,在5-52年間復發。疼痛部位包括:手臂、手、肩膀、胸與頸。肢體疼痛是單側的,但是在每次發作時可能會在不同側發生。肢體疼痛前、中、後發生頭痛(8個人中有7人有某種形式的先兆),成年人的肢體疼痛可能在沒有頭痛時發生。
  
  這個狀況的發生程度可能隨著年齡而改變,孩童通常有肢體疼痛而沒有頭痛。Angus-Leppan醫師表示,孩童的肢體疼痛很像那些發生偏頭痛的人,令人臉色發青,他們往往無法活動,然後慢慢恢復。對於許多孩童而言,隨著年紀增加,發作頻率會降低,但是可能會發生偏頭痛性頭痛或其他症狀。
  
  年長者可能會有不太嚴重的頭痛和比較多的視覺先兆。因此,她表示,充分瞭解家族史,以便能夠為偏頭痛症狀進行適當分類是很重要的,這將有助於治療。
  
  Angus-Leppan 醫師強調,對於避免不必要的檢查和讓患者接受適當治療,確認偏頭痛時的肢體疼痛是很重要的。
  
  在成年人,肢體疼痛的偏頭痛原因通常被誤認為神經受壓、神經根病變、胸廓出口症候群、慢性疲勞症候群、功能性症狀、關節炎。在孩童,可能被誤認為成長痛、骨或關節病變、不想上學。
  
  一旦確認,Angus-Leppan醫師表示,這個症狀相當有助於急性治療和預防偏頭痛,它的原理和其他偏頭痛的表現一樣。
  
  會議主持人、英國皇家醫學會臨床神經科學部前任理事長、倫敦帝國學院榮譽資深講師Russell Lane醫師發表評論時指出,這篇大型且有充分家族特徵的研究提出的問題是,是否這是單一基因突變或者複雜的突變確定此特定表現型。
  
  在診斷方面,他表示,如果肢體疼痛發生在明確發作的偏頭痛時,它顯然是有所關聯。但是,我的印象是,有時患者不會提到肢體疼痛或其他軀體疼痛表現。
  
  Lane醫師表示,偏頭痛發作時的其他疼痛可能包括假性心絞痛與頭痛,病患可能會因為被懷疑有冠狀動脈血栓形成而住進加護病房。
  
  他表示,幼童也可能會有腹痛,經常被懷疑患有闌尾炎,許多孩童可能因此被切除闌尾,事實上,他們一直有相當於偏頭痛的情況。這可能造成有相當高比率的正常闌尾被切除。
  
  Lane醫師表示,偏頭痛可能會出現其他不尋常的症狀,例如雷諾氏現象(Reynaud's phenomenon)和暈厥,這些情況反應出較引人注目的鈣拮抗劑。所以,良好的病史可以發現這類情況,引導進行有效的療法,並且避免不必要的檢測、轉診、誤診、延誤診斷和痛苦。
  
  資料來源: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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