145 Contents lists available at Vilnius University Press Acta medica Lituanica ISSN 1392-0138 eISSN 2029-4174 2021. Vol. 28. No 1, pp. 145–152 DOI: https://doi.org/10.15388/Amed.2021.28.1.19 De novo Migraine with Aura in the Tird Trimester of Pregnancy: A Case Report and Literature review Elena Paškevičiūtė* ORCID: https://orcid.org/0000-0002-1847-5640 Vilnius University, Faculty of Medicine, Vilnius, Lithuania Diana Bužinskienė ORCID: https://orcid.org/0000-0002-4522-0600 Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania Kristina Ryliškienė ORCID: https://orcid.org/0000-0001-9596-1733 Department of Neurology and Neurosurgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania Abstract. Background: Among all headache disorders, migraine has the highest prevalence during gestation. Te majority of migraineurs experience improvement during pregnancy, but a few may experience migraine for the frst time. Tis poses a diagnostic challenge in the diferential diagnosis between primary and life-threaten- ing secondary headache disorders. Because pregnancy itself is an independent risk factor for secondary head- ache disorders, it is mandatory to exclude these conditions in order to diagnose migraine. Tere is a large body of literature about pre-existing migraine course during pregnancy and its link with adverse pregnancy outcomes, but there are no studies examining these aspects among women with new-onset migraine during pregnancy. Case report. A 31-year-old female at 33 weeks of gestation (gravida 2, para 2) was referred to the neurolo- gist eds disturbances, which were followed by pressing severe headache, rated as 8 out of 10 on a numeric rat- ing scale and accompanied by dizziness. Te headache lasted for one day, and dizziness continued to the fol- lowing day. Te patient was investigated for a secondary headache disorder, but laboratory and neuroimaging results were unremarkable. A migraine with aura was diagnosed. Te patient was advised to keep a consistent sleep schedule, maintain regular low physical activity, eat regularly and take magnesium supplementation. Te patient was informed about a safe treatment approach in case of an acute attack. At 40 weeks of gestation the patient delivered female newborn, weighing 3750g, with Apgar scores of 8 and 9 (due to a nuchal cord). Te postpartum period was uneventful. During the subsequent 4 years, the patient did not experience any recurrent migraine attacks and had no pregnancies. Conclusion. In order to diagnose a migraine during pregnancy, exclusion of secondary headache disorders is mandatory. Pregnant migraineur should be regularly monitored for adverse birth outcomes. It is essential to educate patients, provide information about the safe treatment of migraine attacks, and explain nonphar- macological prevention and supplementation benefts. Keywords: Migraine with aura; Pregnancy; Secondary headache disorder; Acute headache; Migraine man- agement Received: 26/03/2021. Revised: 28/04/2021. Accepted: 28/04/2021 Copyright © 2021 Elena Paškevičiūtė, Diana Bužinskienė, Kristina Ryliškienė. Published by Vilnius University Press. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. * Corresponding author: Elena Paškevičiūtė, Vilnius University, Faculty of Medicine, M. K Čiurlionio str. 21, LT-03101 Vilnius, Lithuania. E-mail: elena.paskeviciute@mf.stud.vu.lt