Abdominal Pain Associated with Migraine



Fig. 15.1
(a, b) MRI scans showed Dandy-Walker malformation and thin corpus callosum





15.3 Diagnostic Workup of the Case


This patient was diagnosed with childhood/adolescent migraine associated with abdominal pain and simple tic disorder and anxiety disorder as comorbidity. He had tried valproic acid and propranolol as prophylactic managements before, along with several attack treatment options, but none of them were effective. We educated the family and the patient, explained the diagnosis, regulated his daily routines including sleep hygiene, and prescribed flunarizine and added topiramate afterwards. In the first years of follow-up he did well, but then during college period, he complained of severe attacks refractory to all medications, including triptans. We performed three successful great occipital nerve blocks with lidocaine accordingly. He also had specific psychotherapy for psychiatric disturbances and his symptoms relieved clearly. He had only one attack relieved with domperidone together with flurbiprofen without any recurrence in the last years.


15.4 Summary of the Case


A young boy with previous infantile colic and intractable unexplained gastrointestinal disturbances described migrainous headache attacks in the last 5 years. He had psychiatric (tic disorder and generalized anxiety disorder) and variant anatomical (Dandy-Walker malformation) comorbidities. Positive history of migraine and family history supported the diagnosis. Medical management of migraine followed by nerve blocks relieved not only his headache attacks but also all gastrointestinal disturbances, especially vomiting attacks. His quality of life improved and psychiatric comorbidities were also better.


15.5 Definition According to the International Classification of Headache Disorders (ICHD)


This case was diagnosed as “abdominal migraine” at first. According to ICHD-III beta, it was coded as 1.6.1.2. Recommended diagnostic criteria were as follows:

A.

At least five attacks of abdominal pain, fulfilling criteria B–D

 

B.

Pain has at least two of the following three characteristics:

1.

Midline location, periumbilical or poorly localized

 

2.

Dull or “just sore” quality

 

3.

Moderate or severe intensity

 

 

C.

During attacks, at least two of the following:

1.

Anorexia

 

2.

Nausea

 

3.

Vomiting

 

4.

Pallor

 

 

D.

Attacks last 2–72 h when untreated or unsuccessfully treated

 

E.

Complete freedom from symptoms between attacks

 

F.

Not attributed to another disorder

 

In the following period, the same case was diagnosed with migraine without aura. According to ICHD-III beta, this was coded as 1.1. Recommended diagnostic criteria were as follows;

A.

At least five attacks fulfilling criteria B–D

 

B.

Headache attacks lasting 4–72 h (untreated or unsuccessfully treated)1

 

C.

Headache has at least two of the following four characteristics:

1.

Unilateral location

 

2.

Pulsating quality

 

3.

Moderate or severe pain intensity

 

4.

Aggravation by or causing avoidance of routine physical activity

 

 

Jul 4, 2016 | Posted by in HEAD AND NECK SURGERY | Comments Off on Abdominal Pain Associated with Migraine

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