Abdominal migraine in adults: a review of pharmacotherapeutic options

To report the case of a 32-year-old woman with abdominal migraine and present a literature review to evaluate abdominal migraine in adults, with particular regard to effective treatment.

A 32-year-old African American female presented with recurrent, severe abdominal pain. The patient had several previous admissions with similar symptoms and an extensive gastrointestinal workup in which findings were normal. Attacks of abdominal pain occurred despite treatment with analgesics and antiemetics. She had a family history of migraine headaches. A diagnosis of abdominal migraine was presumed and prophylactic therapy with topiramate 50 mg twice daily relieved the symptoms.

Most published cases of adult abdominal migraine describe females who had a long history of abdominal pain refractory to conventional therapies. The majority of patients had a strong family history of migraine and reported similar episodic abdominal pain. Patients responded to prophylactic migraine therapies, including calcium channel blockers, β-blockers, topiramate, and antihistamines; a few responded to abortive sumatriptan therapy.

Abdominal migraine should be considered a possible source of incurable abdominal pain in adults when accompanied by a complete gastrointestinal workup with normal results. We recommend a trial of topiramate as prophylactic therapy if abdominal migraine is the likely source of the pain.