Stomach pain now blamed on migraine

Dear Dr. Roach: I am a 66-year-old white male who is very physically active. Until four years ago, the only real malady I suffered from was a benign enlarged prostate. In March 2016, I went to the emergency room for acute abdominal pain and cramping. It was relieved by intravenous pain medication. I have experienced the same symptoms approximately 12 more times. I have had two MRIs, an MRA, two CAT scans, a gallbladder test, two colonoscopies, one endoscopy and four hydrogen breath tests. I have been seen by two primary care physicians and two gastroenterologists and numerous emergency room physicians and physician assistants. No medical authority has been able to determine exactly why I have these episodes.

I have been told that I may have Crohn’s disease and irritable bowel syndrome. The latest is abdominal migraine.Can you tell me anything about abdominal migraine? — R.H.

Abdominal migraine does indeed cause recurrent abdominal pain, and many people with it have had extensive evaluations before the diagnosis is made. However, migraine of any kind starting in the 60s is uncommon. Further, most people with abdominal migraine have other migraine syndromes, though it is possible to have abdominal symptoms.

The location of abdominal migraine is most commonly around the umbilicus. Pain often begins suddenly and lasts an hour or more. The pain must be associated with at least two of the following: nausea, vomiting, headache, loss of appetite or pallor. Often, a trial of anti-migraine medication can confirm the diagnosis if successful. There are many. Of course, a thorough evaluation for other causes of abdominal pain are mandatory before making the diagnosis of abdominal migraine.