Abdominal Migraines: A Rare Adulthood Manifestation of a Typical Childhood Disease.

Abstract

Abdominal migraine (AM) is a common childhood disease that rarely presents in adulthood. While multiple diagnostic guidelines have been established, AM can generally be described as unprovoked episodes of acute central abdominal pain with migrainous features and periods of relief. AM is believed to be caused by a disturbance in the gut-brain axis. We are presenting a case of a 47-year-old Caucasian female with a six-month history of abdominal pain and vomiting. The episodes occurred one to two times per week, for 12-18 hours. These episodes were unprovoked and the patient felt normal in between episodes. Her past medical history is notable for hypertension and childhood migraines. Extensive imaging and laboratory workups were unremarkable. A trial of as-needed 50-milligram sumatriptan was started. The patient's symptoms were aided and became less frequent over the next three months. Although uncommon, this patient's case presents convincing evidence of AM. Cyclic vomiting syndrome (CVS), another disease of gut-brain access, was once thought to be a pediatric disease. However, further research showed relevant prevalence in the adult population. CVS has a similar mechanism and treatment plan to AM. It seems plausible that a closely related gut-brain axis disorder like AM could have more prevalence in the adult population. To better identify AM in adults, it is important that physicians inquire about a history of childhood migraines when faced with vague abdominal symptoms. Increased identification of AM will help guide treatment and improve patient outcomes.