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An Approach to the Patient With Abdominal Migraine

An Approach to the Patient With Abdominal Migraine

THE CASE:

A bright, active 10-year-old boy has been experiencing recurrent bouts of
abdominal pain with nausea and occasional vomiting for 3 years. Although he
has had 1 or 2 attacks at school, the pain usually occurs at home—frequently
on weekends. His mother has been unable to correlate these episodes with particular
foods or activities. She notes that her son has experienced motion sickness
during long auto trips and during a family holiday in the mountains of
Colorado.

In infancy and until the age of 3 years, the child had multiple episodes of
vomiting. When he was about 5 years old, he complained of nausea and dizziness
after swinging as well as after a trip to an amusement park.

The mother has tried to ascertain whether the pain might be stress-related. Her son has had attacks at times that might be considered stressful, such as before
a soccer game or birthday party; however, he also has them at home. The
mother reports that when her son has an episode, he stops what he is doing and
lies down in a darkened room. On a few occasions, vomiting has relieved the
pain. The mother has migraine headaches and recalls that vomiting relieved
the attacks she had in high school.

To manage the pain, the parents have used over-the-counter remedies, such
as antacids, but the attacks usually resolve in 2 to 4 hours without treatment.

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