Adult Abdominal Migraine Presenting with Abdominal Myofascial Pain Syndrome: Case Report

Abstract

Background: Abdominal migraine in adults is poorly understood and often undiagnosed. It results in recurrent episodes of abdominal pain associated with nausea, vomiting, and retching. Abdominal myofascial pain syndrome is a common but unrecognized cause of chronic abdominal wall pain. Abdominal migraine can result in abdominal myofascial pain syndrome due to either trauma to the rectus abdominis muscle from excessive retching or due to viscerosomatic convergence from underlying esophageal-gastric inflammation. Objective: Our objective is to present a case report of undetected abdominal migraine in an adult patient presenting with abdominal myofascial pain syndrome and its diagnosis following successful management of abdominal myofascial pain syndrome. Study Design: This case report describes a patient presenting with 3 different types of abdominal pain to a pain medicine clinic. Setting: The patient was seen in a tertiary pain medicine clinic based in a university teaching hospital. Methods: This report describes the successful management of abdominal myofascial pain syndrome by trigger point treatment with depot steroids followed by pulsed radiofrequency treatment. Results: Successful management of abdominal myofascial pain syndrome resulted in subsequent diagnosis of abdominal migraine. There was improvement reported in pain intensity scores, quality of life, anxiety, and depression scores following the interventional management of abdominal myofascial pain syndrome as well as abdominal migraine. Limitations: This report represents a single patient presenting with a previously unreported combination of persistent abdominal pain. Conclusion: Abdominal migraine and abdominal myofascial pain syndrome are often unrecognized conditions that result in significant health care utilization. Undiagnosed abdominal migraine can result in abdominal myofascial pain syndrome and this can result in a delay in the correct diagnosis of abdominal migraine. Key words: Abdominal migraine, abdominal myofascial pain syndrome, chronic abdominal wall pain, trigger point treatment, viscerosomatic convergence