[Abdominal migraine in adults]

Area of Science:

• Neurology
• Gastroenterology
• Clinical Case Study

Background:

• Abdominal migraine is a functional gastrointestinal disorder characterized by recurrent episodes of abdominal pain.
• It often affects children but can persist into adulthood, presenting diagnostic challenges due to its varied symptomatology.
• Family history of migraine is a significant risk factor, suggesting a potential genetic predisposition.

Observation:

• A 35-year-old woman presented with a four-year history of severe, nocturnal abdominal pain, nausea, vomiting, diarrhea, and transient loss of consciousness.
• Attacks occurred exclusively between 1-3 a.m., relieved by emesis and defecation, with post-attack weakness and numbness.
• Extensive gastrological and neurological investigations, including EEG and cranial CT, were unremarkable, ruling out organic pathology and epilepsy.

Findings:

• The patient's history of childhood paroxysmal abdominal pain and her mother's migraine supported a diagnosis of abdominal migraine.
• Treatment with Pizotifen (1.5 mg/day) for three months completely resolved the nocturnal attacks.
• Upon discontinuation, attacks recurred but were less severe; subsequent treatment with Nitrendipine (5 mg/night) ceased the episodes, though the patient preferred Pizotifen.

Implications:

• This case underscores the importance of considering abdominal migraine in adults with recurrent, unexplained nocturnal abdominal pain, especially with a migraineous background.
• Pharmacological management, including Pizotifen and potentially other migraine prophylactic agents, can be effective in controlling severe symptoms.
• Further research into the pathophysiology and optimal treatment strategies for adult abdominal migraine is warranted.