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診断分類ICHD-3β

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Table 1. Vestibular migraine: diagnostic criteria.
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Vestibular migraine
A. At least five episodes fulfilling criteria C and D
B. A current or past history of 1.1 Migraine without aura or 1.2 Migraine with aura1
C. Vestibular symptoms2 of moderate or severe intensity,3 lasting between 5 minutes and 72 hours4
D. At least 50% of episodes are associated with at least one of the following three migrainous features:5
1. headache with at least two of the following four characteristics:
a) unilateral location
b) pulsating quality
c) moderate or severe intensity
d) aggravation by routine physical activity
2. photophobia and phonophobia6
3. visual aura7
E. Not better accounted for by another ICHD-3 diagnosis or by another vestibular disorder.8
Notes
(1) Code also for the underlying migraine diagnosis.
(2) Vestibular symptoms, as defined by the Ba´ra´ny Society’s Classification of Vestibular   Symptoms and qualifying for a diagnosis of
A1.6.5 Vestibular migraine, include:
a) spontaneous vertigo:
(i) internal vertigo (a false sensation of self-motion);
(ii) external vertigo (a false sensation that the visual surround is spinning or flowing);
b) positional vertigo, occurring after a change of head position;
c) visually induced vertigo, triggered by a complex or large moving visual stimulus;
d) head motion-induced vertigo, occurring during head motion;
e) head motion-induced dizziness with nausea (dizziness is characterized by a sensation of disturbed spatial orientation; other forms of dizziness are currently not included in the classification of vestibular migraine).
(3) Vestibular symptoms are rated moderate when they interfere with but do not prevent daily  activities, and severe when daily activities cannot be continued.
(4) Duration of episodes is highly variable. About 30% of patients have episodes lasting minutes, 30% have attacks for hours and another 30% have attacks over several days. The remaining 10% have attacks lasting seconds only, which tend to occur repeatedly during head motion, visual stimulation or after changes of head position. In these patients, episode duration is defined as the total period during which short attacks recur. At the other end of the spectrum, there are patients who may take 4 weeks to recover fully from an episode. However, the core episode rarely exceeds 72 hours.
(5) One symptom is sufficient during a single episode. Different symptoms may occur during different episodes. Associated symptoms may occur before, during or after the vestibular symptoms.
(6) Phonophobia is defined as sound-induced discomfort. It is a transient and bilateral phenomenon that must be differentiated from recruitment, which is often unilateral and persistent. Recruitment leads to an enhanced perception and often distortion of loud sounds in an ear with decreased hearing.
(7) Visual auras are characterized by bright scintillating lights or zigzag lines, often with a scotoma that interferes with reading. Visual auras typically expand over 5–20 minutes and last for less than 60 minutes. They are often, but not always restricted to one hemifield. Other types of migraine aura, for example somatosensory or dysphasic aura, are not included as diagnostic criteria because their phenomenology is less specific and most patients also have visual auras.
(8) History and physical examinations do not suggest another vestibular disorder, or such a disorder has been considered but ruled out by appropriate investigations or such a disorder is present as a comorbid or independent condition, but episodes can be clearly differentiated. Migraine attacks may be induced by vestibular stimulation. Therefore, the differential diagnosis should include other vestibular disorders complicated by superimposed migraine attacks.

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