Frederick B. Peng, MD, Manreet Kaur, MD
Baylor College of Medicine, Houston, TX
Introduction: Chronic abdominal pain is a challenging, but frequently encountered clinical complaint. For adults, the symptoms are often debilitating and have significant implications on their daily lives. Often, these patients have undergone extensive work-up with laboratory testing and imaging that have either been unrevealing or non-specific. The history therefore becomes a key element in delineating potential etiologies. Here, we present a case of recurrent periumbilical abdominal pain in an adult with historical elements consistent with abdominal migraine – a clinical entity more commonly described in pediatric patients.
Case Description/Methods: A 52-year-old man with diabetes and hypertension requiring renal transplant presented with 48 hours of periumbilical abdominal pain, increased eructation, and bilious emesis. For years, his symptoms had been minimally managed with IV fluids, analgesia, and anti-emetics during emergency room visits or hospital admissions. His last pain episode was a year ago. Work-up has been extensive and largely unrevealing, including multiple endoscopies, several CT scans, and a gastric emptying study. These episodes are intense, triggered by a lack of sleep, and often last a day or more with intermittent periods of relief (weeks to months). The pain is always associated with nausea, vomiting, and photophobia. He has a family history of migraines, but no personal history of headaches. On exam, he is hemodynamically stable, but purposely keeps the room dark. He has normoactive bowel sounds and is mildly tender to palpation in the periumbilical region. There is no rebound tenderness or guarding. Laboratory and imaging findings are unremarkable. Of note, his symptoms were previously managed with amitriptyline. A single dose of sumatriptan relieves his pain and he is discharged with outpatient GI follow-up.
Discussion: An abdominal migraine is a diagnosis of exclusion and its diagnostic criteria is delineated in Rome IV (Table). The described prodrome often resembles that of a typical migraine and management is similar. Prophylactic therapies include amitriptyline, propranolol, and topiramate, while abortive therapies involve triptans. Thus far, the disease entity is more commonly seen in pediatrics, but there is an increasing number of cases reported in adults. Like other functional GI disorders, a thorough history after comprehensive evaluation of all other etiologies differentiates abdominal migraine as a distinct clinical entity.
Citation: Frederick B. Peng, MD, Manreet Kaur, MD. P1260 - CHRONIC PERIUMBILICAL ABDOMINAL PAIN: ABDOMINAL MIGRAINE IN AN ADULT. Program No. P1260. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.