4．めまいを伴う頭痛診療における鑑別診断と評価指標

抄録

The interplay between dizziness, vertigo, and headache has been a subject of longstanding clinical debate. This review aims to provide a comprehensive overview of the current understanding regarding the classification, pathogenesis, and management of this complex clinical presentation. It focuses on the International Classification of Headache Disorders, Third Edition (ICHD-III), which provides a comprehensive framework for the classification of headache disorders. Particular attention is paid to “migraine with brainstem aura,” “vestibular migraine,” and “hemiplegic migraine,” as these subtypes are often challenging to differentiate clinically due to their overlapping symptomatology with dizziness and vertigo. The underlying pathophysiological mechanisms linking dizziness, vertigo, and headache are multifaceted and not yet fully elucidated. Emerging evidence suggests that shared neuroanatomical and neurochemical pathways may contribute to the co-occurrence of these symptoms. Detailed exploration of the underlying pathogenetic pathways is crucial for developing targeted therapeutic interventions. Various clinical assessment tools, including the Headache Diary, are discussed as valuable resources for accurate diagnosis and targeted treatment of headache disorders associated with dizziness and vertigo. These assessment measures can facilitate effective physician-patient communication and optimize clinical decision-making. The complex relationship between dizziness, vertigo, and headache requires a thorough understanding of the underlying pathophysiology and a systematic approach to clinical evaluation and management. Adoption of validated assessment tools can contribute to improved patient outcomes and strengthen the clinician’s ability to provide evidence-based care.