一位意外懷孕婦女眩暈症

Vertigo in a Woman with Unexpected Pregnancy

一37歲已婚女性，在18-25歲時罹患無預兆偏頭痛。29歲發作了第1次的眩暈症，合併噁心、嘔吐、怕光及怕吵。30歲確診為不孕症。32歲時，一樣的眩暈又發作，接受了止暈及止吐的症狀治療；由於月經延遲，遂安排懷孕測試，結果顯示為陽性。10個月後順利產下1名健康女嬰。產後8個月，一樣的眩暈又發作，因正值哺乳，遂不建議任何藥物。爾後4年，相同的眩暈又發作了5次，遂確診為前庭性偏頭痛。因此，只要是生育年齡的女性眩暈患者，就有潛在懷孕的機會，即使是已經確診為不孕症。在沒有完全排除懷孕前，須避免使用任何會致畸胎的藥物，症狀治療首選美國食品藥物管理局懷孕風險分類B級的藥物，例如diphenhydramine或promethazine等抗組織胺，以及metoclopramide止吐劑，其次才是懷孕風險分類C級之prochlorperazine止吐劑及diphenidol止暈劑；至於抗組織胺betahistine尚未有足夠資料進行分類，最好不要貿然使用。

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.