Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations

Abstract

Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.

Vertigo During Pregnancy: A Narrative Review of the Etiology, Pathophysiology, and Treatment

“…To improve circulation; patients should avoid standing for extended periods and make sure to move about when they are. In order to prevent BPPV, vitamin D3 supplements must be given to pregnant women [ 44 , 45 ].…”

Vestibular Migraine Therapy: Update and Recent Literature Review

“…Safety data as well as efficacy data for neuromodulation devices are missing. Among non-pharmacological preventive interventions, acupuncture is considered safe in pregnancy [18].…”

Exploring Depression and Nutritional Covariates Amongst US Adults using Shapely Additive Explanations

“…Given the detrimental effects of depression, it is imperative to increase research on potential treatments and interventions 14,15 . Lifestyle changes, including diet and exercise, have been identified as potential avenues for treatment 16–20 . In addition, there is a growing body of evidence on specific nutritional targets that are inversely associated with depression.…”

“…14,15 Lifestyle changes, including diet and exercise, have been identified as potential avenues for treatment. [16][17][18][19][20] In addition, there is a growing body of evidence on specific nutritional targets that are inversely associated with depression. In our enhanced data set, we examine all the nutrition covariates to determine their potential impact on depressive symptoms.…”