Comparative study of clinical features and vascular risk factors in patients with unexplained non-acute dizziness and headache in cerebrovascular disease clinic_West China Medical Journal

Authors：

SONG Xindi , GUO Wen , LIU Meng , DENG Yilun , WU Qian , WANG Yanan , YE Kaili ,  LIU Ming

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Ming, Email: liuming201502@163.com

Keywords：

Dizziness; unexplained; vascular risk factor; comparative study

DOI：

10.7507/1002-0179.202203104

Video：

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Objective To analyze the difference of clinical characteristics and vascular risk factors between patients with unexplained non-acute dizziness and headache, so that to bring new perspective on prevention of vascular risk factors and enhancement of symptoms among different patients. Methods The data of patients in the cerebrovascular disease clinic of the Department of Neurology, West China Hospital of Sichuan University between July 1th and September 30th, 2021 were collected retrospectively. The included patients were divided into dizziness group or headache group according to the complained. The clinical characteristics and risk factors of the two groups were compared. Results A total of 273 patients were included. There were 198 cases (72.5%) in dizziness group and 75 cases (27.5%) in headache group. Compared with headache group, patients in dizziness group were older, with a shorter course of disease, and accounted for a higher proportion of patients with symptoms related to body position, higher proportion of patients with hypertension and carotid plaque, and more vascular risk factors (P<0.05). Logistic regression results showed that patients with symptoms related to body position [odds ratio (OR)=7.025, 95% confidence interval (CI) (1.772, 28.488), P=0.007], at least one [OR=2.461, 95%CI (1.298, 4.664), P=0.006], two or more vascular risk factors [OR=2.314, 95%CI (1.033, 5.186), P=0.042] were independently associated with dizziness. The longer course of disease [OR=0.994, 95%CI (0.990, 0.997), P=0.001] was independently associated with headache. Conclusion Patients with non-acute unexplained dizziness and headache, especially those with dizziness, should pay more attention to the inquiry and treatment of vascular risk factors and psychopsychological factors.

Citation： SONG Xindi, GUO Wen, LIU Meng, DENG Yilun, WU Qian, WANG Yanan, YE Kaili, LIU Ming. Comparative study of clinical features and vascular risk factors in patients with unexplained non-acute dizziness and headache in cerebrovascular disease clinic. West China Medical Journal, 2022, 37(6): 844-849. doi: 10.7507/1002-0179.202203104 Copy

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2.	Maarsingh OR, Dros J, Schellevis FG, et al. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med, 2010, 8(3): 196-205.
3.	朱燚, 周东. 门诊头痛患者 1700 例的临床分析. 华西医学, 2008, 23(3): 462-463.
4.	陶建青. 2061 例头痛患者的病因分析. 山东医药, 2014, 54(12): 82-84.
5.	薛立伏, 冯莹莹, 韩玉晶, 等. 850 例门诊头痛患者的病因分析. 中西医结合心脑血管病杂志, 2015, 13(10): 1233-1235.
6.	薛慧, 崇奕, 蒋子栋, 等. 神经内科眩晕/头晕患者的病因分析. 中华医学杂志, 2018, 98(16): 1227-1230.
7.	曹鹏禹, 刘红巾, 徐先荣, 等. 门诊主诉"眩晕或头晕"患者病因分层分析. 听力学及言语疾病杂志, 2020, 28(6): 631-635.
8.	王朝霞, 李远军, 徐先荣, 等. 眩晕中心门诊 1419 例患者的病因分层研究. 中华临床医师杂志(电子版), 2018, 12(4): 218-222.
9.	Rego ÂR, Dias D, Pinto A, et al. The cardiovascular aspects of a Ménière's disease population-a pilot study. J Otol, 2019, 14(2): 51-56.
10.	Minen MT, Weissman J, Tietjen GE. The relationship between migraine or severe headache and chronic health conditions: a cross-sectional study from the national health interview survey 2013-2015. Pain Med, 2019, 20(11): 2263-2271.
11.	Di Carlo A, Lamassa M, Baldereschi M, et al. Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The european community stroke project. J Neurol Sci, 2006, 244(1/2): 143-150.
12.	Wu B, Lin S, Hao Z, et al. Proportion, risk factors and outcome of lacunar infarction: a hospital-based study in a Chinese population. Cerebrovasc Dis, 2010, 29(2): 181-187.
13.	Alla S, Rao MY, Aslam SM. Clinical profiles of elderly patients presenting with persistent dizziness. J Natl Med Assoc, 2020, 112(4): 362-373.
14.	Do TP, la Cour Karottki NF, Ashina M. Updates in the diagnostic approach of headache. Curr Pain Headache Rep, 2021, 25(12): 80.
15.	Wang YF, Wang SJ. Hypertension and migraine: time to revisit the evidence. Curr Pain Headache Rep, 2021, 25(9): 58.
16.	Finocchi C, Sassos D. Headache and arterial hypertension. Neurol Sci, 2017, 38(Suppl 1): 67-72.
17.	Yilmaz Avci A, Akkucuk MH, Torun E, et al. Migraine and subclinical atherosclerosis: endothelial dysfunction biomarkers and carotid intima-media thickness: a case-control study. Neurol Sci, 2019, 40(4): 703-711.
18.	刘鸣, 刘峻峰, 吴波. 脑血管病分类分型进展与解读. 中华神经科杂志, 2017, 50(3): 163-167.
19.	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类 2015. 中华神经科杂志, 2017, 50(3): 168-171.
20.	Lahmann C, Henningsen P, Brandt T, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry, 2015, 86(3): 302-308.
21.	Stubberud A, Buse DC, Kristoffersen ES, et al. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain, 2021, 22(1): 155.
22.	代瑞红, 廖晓阳. 失眠与紧张性头痛及其诱因间关系的研究进展. 中国全科医学, 2020, 23(36): 4615-4618.
23.	黄颐, 孙学礼. 心身障碍病因学理论研究进展. 华西医学, 2005, 20(1): 162-163.
24.	O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet, 2016, 388(10046): 761-775.
25.	Bassetti CLA, Randerath W, Vignatelli L, et al. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol, 2020, 27(7): 1117-1136.
26.	Serrador JM, Hughson RL, Kowalchuk JM, et al. Cerebral blood flow during orthostasis: role of arterial CO₂. Am J Physiol Regul Integr Comp Physiol, 2006, 290(4): R1087-R1093.
27.	Sándor P. Nervous control of the cerebrovascular system: doubts and facts. Neurochem Int, 1999, 35(3): 237-259.
28.	Serrador JM, Shoemaker JK, Brown TE, et al. Cerebral vasoconstriction precedes orthostatic intolerance after parabolic flight. Brain Res Bull, 2000, 53(1): 113-120.
29.	Wilson TD, Serrador JM, Shoemaker JK. Head position modifies cerebrovascular response to orthostatic stress. Brain Res, 2003, 961(2): 261-268.
30.	Saavedra JM, Nishimura Y. Angiotensin and cerebral blood flow. Cell Mol Neurobiol, 1999, 19(5): 553-573.
31.	Zebenholzer K, Andree C, Lechner A, et al. Prevalence, management and burden of episodic and chronic headaches-a cross-sectional multicentre study in eight Austrian headache centres. J Headache Pain, 2015, 16: 531.

1. Bronstein AM, Lempert T. Management of the patient with chronic dizziness. Restor Neurol Neurosci, 2010, 28(1): 83-90.
2. Maarsingh OR, Dros J, Schellevis FG, et al. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med, 2010, 8(3): 196-205.
3. 朱燚, 周东. 门诊头痛患者 1700 例的临床分析. 华西医学, 2008, 23(3): 462-463.
4. 陶建青. 2061 例头痛患者的病因分析. 山东医药, 2014, 54(12): 82-84.
5. 薛立伏, 冯莹莹, 韩玉晶, 等. 850 例门诊头痛患者的病因分析. 中西医结合心脑血管病杂志, 2015, 13(10): 1233-1235.
6. 薛慧, 崇奕, 蒋子栋, 等. 神经内科眩晕/头晕患者的病因分析. 中华医学杂志, 2018, 98(16): 1227-1230.
7. 曹鹏禹, 刘红巾, 徐先荣, 等. 门诊主诉"眩晕或头晕"患者病因分层分析. 听力学及言语疾病杂志, 2020, 28(6): 631-635.
8. 王朝霞, 李远军, 徐先荣, 等. 眩晕中心门诊 1419 例患者的病因分层研究. 中华临床医师杂志(电子版), 2018, 12(4): 218-222.
9. Rego ÂR, Dias D, Pinto A, et al. The cardiovascular aspects of a Ménière's disease population-a pilot study. J Otol, 2019, 14(2): 51-56.
10. Minen MT, Weissman J, Tietjen GE. The relationship between migraine or severe headache and chronic health conditions: a cross-sectional study from the national health interview survey 2013-2015. Pain Med, 2019, 20(11): 2263-2271.
11. Di Carlo A, Lamassa M, Baldereschi M, et al. Risk factors and outcome of subtypes of ischemic stroke. Data from a multicenter multinational hospital-based registry. The european community stroke project. J Neurol Sci, 2006, 244(1/2): 143-150.
12. Wu B, Lin S, Hao Z, et al. Proportion, risk factors and outcome of lacunar infarction: a hospital-based study in a Chinese population. Cerebrovasc Dis, 2010, 29(2): 181-187.
13. Alla S, Rao MY, Aslam SM. Clinical profiles of elderly patients presenting with persistent dizziness. J Natl Med Assoc, 2020, 112(4): 362-373.
14. Do TP, la Cour Karottki NF, Ashina M. Updates in the diagnostic approach of headache. Curr Pain Headache Rep, 2021, 25(12): 80.
15. Wang YF, Wang SJ. Hypertension and migraine: time to revisit the evidence. Curr Pain Headache Rep, 2021, 25(9): 58.
16. Finocchi C, Sassos D. Headache and arterial hypertension. Neurol Sci, 2017, 38(Suppl 1): 67-72.
17. Yilmaz Avci A, Akkucuk MH, Torun E, et al. Migraine and subclinical atherosclerosis: endothelial dysfunction biomarkers and carotid intima-media thickness: a case-control study. Neurol Sci, 2019, 40(4): 703-711.
18. 刘鸣, 刘峻峰, 吴波. 脑血管病分类分型进展与解读. 中华神经科杂志, 2017, 50(3): 163-167.
19. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类 2015. 中华神经科杂志, 2017, 50(3): 168-171.
20. Lahmann C, Henningsen P, Brandt T, et al. Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness. J Neurol Neurosurg Psychiatry, 2015, 86(3): 302-308.
21. Stubberud A, Buse DC, Kristoffersen ES, et al. Is there a causal relationship between stress and migraine? Current evidence and implications for management. J Headache Pain, 2021, 22(1): 155.
22. 代瑞红, 廖晓阳. 失眠与紧张性头痛及其诱因间关系的研究进展. 中国全科医学, 2020, 23(36): 4615-4618.
23. 黄颐, 孙学礼. 心身障碍病因学理论研究进展. 华西医学, 2005, 20(1): 162-163.
24. O'Donnell MJ, Chin SL, Rangarajan S, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet, 2016, 388(10046): 761-775.
25. Bassetti CLA, Randerath W, Vignatelli L, et al. EAN/ERS/ESO/ESRS statement on the impact of sleep disorders on risk and outcome of stroke. Eur J Neurol, 2020, 27(7): 1117-1136.
26. Serrador JM, Hughson RL, Kowalchuk JM, et al. Cerebral blood flow during orthostasis: role of arterial CO₂. Am J Physiol Regul Integr Comp Physiol, 2006, 290(4): R1087-R1093.
27. Sándor P. Nervous control of the cerebrovascular system: doubts and facts. Neurochem Int, 1999, 35(3): 237-259.
28. Serrador JM, Shoemaker JK, Brown TE, et al. Cerebral vasoconstriction precedes orthostatic intolerance after parabolic flight. Brain Res Bull, 2000, 53(1): 113-120.
29. Wilson TD, Serrador JM, Shoemaker JK. Head position modifies cerebrovascular response to orthostatic stress. Brain Res, 2003, 961(2): 261-268.
30. Saavedra JM, Nishimura Y. Angiotensin and cerebral blood flow. Cell Mol Neurobiol, 1999, 19(5): 553-573.
31. Zebenholzer K, Andree C, Lechner A, et al. Prevalence, management and burden of episodic and chronic headaches-a cross-sectional multicentre study in eight Austrian headache centres. J Headache Pain, 2015, 16: 531.

West China Medical Journal

Comparative study of clinical features and vascular risk factors in patients with unexplained non-acute dizziness and headache in cerebrovascular disease clinic

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