Migrainous Vertigo during Pregnancy, a Ten-Year Experience

Objectives: For most people, vertigo attack is a terrible experience regardless of his or her ages or genders. For women, pregnancy is a hard challenge no matter in physiological or in psychological aspects. Thus vertigo attacks during pregnancy will be a strong impact to pregnant women and a troublesome problem for physicians. According to our experience, migrainous vertigo is seen to play an important role in this condition. Therefore we attempt to investigate the cases with migrainous vertigo during pregnancy in the past 10 years. Background: This is a retrospective case review study in an university hospital. Methods: From January 1994 to December 2003, 45 consecutive patients with their ages ranging from 22 to 43(mean 32) years visited the authors' clinic due to acute vertigo attack during pregnancy. The diagnosis of migrainous vertigo was made in 24 patients including 3 patients of migraine with aura and 21 patients of migraine without aura. Other cases included 6 patients of idiopathy sudden sensorineurial hearing loss, 5 orthostatic hypotension, 4 endolymphatic hydrops, 4 vestibulopathy, 1 acoustic neuroma, and 1 herpes zoster oticus. No preeclampsia was noted before delivery and all babies were born with healthy conditions. Results: In migraine without aura group, the vertigo occurred in the first trimester in 7 patients, second trimester 5 and third trimester 9, including 9 patients in advanced maternal age. Furthermore fourteen patients were primipara and 7 were multipara. Eleven patients ever experienced migrainous vertigo before pregnancy and the others were first vertigo attack in her life. As for migraine with aura group, all of their ages were less than 35 years including 2 patients of primipara and 1 multipara. Among them, two patients suffered from acute vertigo in the first trimester and 1 in the second trimester. All patients ever experienced migrainous vertigo attack before pregnancy. Conclusions: More than half patients of acute vertigo during pregnancy were migrainous vertigo. In migraine without aura group, there is no obvious difference among the occurrence rates of the three trimesters (p>0.01) and it was more frequent occurred in pregnant women who is primipara or with advanced maternal age. However, in migraine with aura group, the case number is limited for analysis. In addition to migraine, secondary headache should be considered for differential diagnosis in these cases such as subarachnoid hemorrhage, cerebral venous thrombosis or preeclampsia. In the past 10 years only 24 pregnant patients was enrolled in this study and the prevalence rate was much lower than the age- and sex-matched non- pregnant group. Thus the migrainous vertigo was seen to improve during pregnancy. Nevertheless, not all cases improve during pregnancy. In migraine without aura group, 58 % patients had previous migrainous vertigo history and became worsen after pregnancy. Otherwise all patients in migraine with aura group ever experienced migrainous vertigo attack before pregnancy and the vertigo became more severe when pregnancy proceeded