A case of severe abdominal pain during panic disorder: diagnosis and management of adult abdominal migraine.
Abdominal migraine is classified as a primary headache disorder under the periodic syndromes associated with migraines, according to the International Classification of Headache Disorders, 3rd Edition. Cases in adults are rare and often go unrecognized. Due to the lack of abnormal physical examination findings, particularly in patients with coexisting psychiatric disorders, abdominal migraines are frequently misdiagnosed as psychogenic abdominal pain or somatic complaints, increasing the likelihood of diagnostic errors. We present the case of a male patient in his 50s who was referred to our department with severe abdominal pain initially attributed to psychogenic causes related to his panic disorder. However, the patient was ultimately diagnosed with abdominal migraine in adulthood and showed notable improvement with triptan therapy. He had been receiving treatment for panic disorder in our department since year X-13 and had frequently visited the emergency department with complaints of chest pain, although no underlying causative condition was identified. Around July X-2, the patient began experiencing abdominal pain, but no abnormalities were detected. On March 7, X, he experienced severe abdominal pain that impaired his ability to walk, necessitating emergency transportation and admission to a nearby general hospital for a comprehensive evaluation. Despite extensive testing, no severe abnormalities were identified, and psychogenic pain was considered the most likely diagnosis. Consequently, on March 9, the patient was transferred to our department for further evaluation. On the fifth day of hospitalization, he experienced another episode of severe abdominal pain. Although diclofenac suppositories were administered, they provided only limited relief. Further investigations during his stay revealed no specific cause for the abdominal pain, suggesting abdominal migraine as a probable differential diagnosis. On the eighth day of hospitalization, during a recurrence of abdominal pain, the patient was treated with triptans, resulting in remarkable pain relief.
