148 [] 1 2 3,4 37 18-25 29 1 3032 10 18 4 5 B diphenhydramine promethazine metoclopramide C prochlorperazinediphenidol betahistine 2014; 24: 148-152 DOI: 10.3966/168232812014092403005 (vestibular migraine) 4 [1] (1) 5 5 72 (2) 3 [2] (3) (a) (b) (c) 1 (4) 60-70% (menstrual migraine) [3] 23.8% 1 (trimester) [4] 1 2 3 4 103 11 27104 3 27104 4 4 404472
103 24 3 149 [3] 63.6% 60.61% 33.33% 1 2 3 (instability) (25.6%) (23.3%) (20.9%) (floating head sensation) (16.3%) (14.0%) (9.3%) (7.0%) (4.7%) [5] 37 21.6 kg/m 2 18-25 2-3 2 (motion intolerance) (migraine without aura) 1 29 30 (sterility) 32 1 110/69 mmhg 73/min 20/min 35.6ºC 3 Hz 2 mm 5 Babinski diphenidol (Cephadol) betahistine (Ecycle) 1 [2] 4-72 * 2 * 1. 2. * 3. * 4. * 1 * 1. / * 2. * * *
Taiwan J Fam Med 150 2014 Vol. 24 No.3 diphenhydramine (Vena) prochlorperazine (Novamin) 2 diphenidol betahistine 10 8 4 5 15 [6] 9 34 8 (primipara) 3 9 5 1 2 (Ménière's disease) 8 (1) (2) (3)-(b) (4) 90% 1 2 3 63.5% 33.8% 26.2% 29.3% 22.1% 14.1% [7] 2 (hyperemesis gravidarum) [8] 2 diphenidol prochlorperazine betahistine diphenhydramine (Food and Drug Administration categories) diphenhydramine B prochlorperazine diphenidolc betahistine D X [3] 3
103 24 3 151 2 B diphenhydramine promethazine B metoclopramide C prochlorperazine diphenidol betahistine B acetaminophen diclofenac ibuprofen naproxen meperidine C aspirin indomethacin mefenamic acid codeine morphine tramadol triptan X ergotamine dihydroergotamine [3] ergotamine [9] diclofenac ibuprofen naproxen aspirin indomethacin mefenamic acid 3 D meperidine D acetaminophen diclofenac ibuprofen sumatriptan metoclopramide prochlorperazine promethazine cyclizine ergotamine dihydroergotamine [3] 1. Lempert T: Vestibular migraine. Semin Neurol 2013; 33: 212-8. 2. Headache Classification Committee of the International Headache Society (IHS): The International Classification of Headache Disorders. 3rd ed (beta version). Cephalalgia 2013; 33: 629-808. 3. MacGregor EA: Migraine in pregnancy and lactation. Neurol Sci 2014; 35: 61-4. 4. Frederick IO, Qiu C, Enquobahrie DA, et al: Lifetime prevalence and correlates of migraine among women in a pacific northwest pregnancy cohort study. Headache 2014; 54: 675-85. 5. Schmidt PM, Flores Fda T, Rossi AG, Silveira AF: Hearing and vestibular complaints during pregnancy. Braz J Otorhinolaryngol 2010; 76: 29-33. 6. 1998 33 319-22 7. Coronado PJ, Fasero M, Álvarez-Sánchez Á, Rey E: Prevalence and persistence of nausea and vomiting along the pregnancy. Rev Esp Enferm Dig 2014; 106: 318-24. 8. Sheehan P: Hyperemesis gravidarum-- assessment and management. Aust Fam Physician 2007; 36: 698-701. 9. Banhidy F, Acs N, Puho E, Czeizel AE: Ergotamine treatment during pregnancy and a higher rate of low birthweight and preterm birth. Br J Clin Pharmacol 2007; 64: 510-6.
152 [Case Report] Vertigo in a Woman with Unexpected Pregnancy Jiann-Jy Chen 1, Dem-Lion Chen 2 and Hsin-Feng Chang 3,4 A 37-year-old married woman had suffered migraine without aura during the period from 18 and 25 years old. The first vertiginous episode occurred when she was 29, accompanied with nausea, vomiting, photophobia and phonophobia. At 30, she was diagnosed with sterility. At 32, the same vertiginous episode recurred and was conservatively treated with several anti-vertigo and anti-emetic medications. Because of missed menstrual periods, she received a pregnancy test and the result was positive. After 10 months, she bore a healthy baby girl. However, 8 months after the delivery, the same vertiginous episode recurred, but she took no medication due to lactation. Over the following 4 years, the same vertiginous episode recurred 5 times. Eventually, she was diagnosed with vestibular migraine. Therefore, pregnancy is possible in a vertiginous woman of childbearing age even if she has been diagnosed with sterility. Any medication with teratogenic risk should be avoided if pregnancy cannot be completely excluded. Antihistamine diphenhydramine (FDA class B) or promethazine (FDA class B), or antiemetics metoclopramide (FDA class B), should be considered first, followed by FDA class C antiemetics prochlorperazine or diphenidol. Antihistamine betahistine, however, should be avoided as there have not been enough data for FDA classification. (Taiwan J Fam Med 2014; 24: 148-152) DOI: 10.3966/168232812014092403005 Key Words: FDA class, pregnancy test, sterility, vertigo, vestibular migraine 1 Department of Neurology, Neuro-Medical Scientific Center, Buddhist Tzu Chi General Hospital, Taichung Branch, Taichung; 2 G-Home Clinic for Otorhinolaryngology and Neurology, Kaohsiung; 3 Department of Medical Education, China Medical University Hospital, Taichung; 4 Faculty of Chinese Medicine, Chinese Medical College, China Medical University, Taichung, Taiwan. Received: November 27, 2014; Revised: March 27, 2015; Accepted: April 4, 2015.