Disclosures: Ann Hulme, MD: No financial relationships or conflicts of interest

Case Description: At initial evaluation, she was sent to the emergency department (ED) and admitted to neurology for urgent workup of urinary and fecal incontinence with right lower extremity sensory changes. MRI brain and spine were unremarkable. Additional work up for abdominal pain, demonstrated cholelithiasis and chronic gastritis. On exam in clinic, her sensation to light touch was diffusely reduced over the right lower extremity, there was tenderness of right more than left superficial and deep pelvic floor muscles, pelvic floor weakness, and reduced coordination for quick contraction/relaxation. Similar symptoms 4 years prior improved with cyclobenzaprine, duloxetine, and pelvic floor physical therapy (PFPT).

Setting: Tertiary care center

Patient: A G4P4003 54 y.o. female with extensive medical history including atypical left hemiplegic migraines with aura, depression, and anxiety who presented with bilateral low back, sacroiliac joint, and pain, chronic constipation, and myofascial pelvic floor pain. Assessment/

Results: ENA profile, ANA, ESR, and CRP levels were normal. MRI pelvis was negative. The patient has left and now right hemiplegic migraines, lumbar, abdominal, and pelvic floor myofascial pain, chronic constipation resulting in overflow fecal incontinence, urinary urge incontinence, and abdominal migraine (AM).

Discussion: More frequently diagnosed in kids, AM should be considered for paroxysmal abdominal pain in adults. AM is an episodic functional disorder on the migraine spectrum with severe abdominal pain. It is associated with common migraine symptoms and episodic syndromes. Most patients are female with a strong family and personal history of migraines. Patients frequently improve with abortive triptan, prophylactic migraine therapies, and avoiding triggers. This patient improved with medications, including steroids, muscle relaxants, bowel regimen, and PFPT.

Conclusion: This is a complex patient with a multitude of complaints that can be explained in part as an abdominal migraine. Chronic abdominopelvic pain can be difficult to diagnose and treat; physicians need to consider abdominal migraines in the differential for patients.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/paroxysmal-abdominopelvic-pain-could-it-be-a-migraine/