成人腹型偏头痛一例报道并文献复习

Adult abdominal migraine:a case report and review of the literature

目的总结成人腹型偏头痛(AM)的临床特点,以提高临床医生对本病的认识和早期诊断率。方法报道1例2019年10月就诊于郑州大学第一附属医院的成人AM患者,并筛选2004年1月至2020年5月医学文献中报道的成人AM患者进行总结。结果共检索到相关文献634篇,其中14篇文献报道共17例成人AM患者,加上本院收治的1例,共18例,其中女性11例。仅2例在发病后1年内确诊,余16例均在数年后才确诊,最长发病后37年确诊。腹痛发作部位和性质多样,发作频率中位数为2.5次/月,16例患者发作持续时间为2~72 h,1例最长持续4 d。14例患者伴恶心,13例伴呕吐,7例伴头痛。15例患者存在偏头痛病史或家族史。16例患者间歇期为1周至数个月。急性期非甾体抗炎药治疗效果不佳,推荐曲坦类药物,必要时可考虑麻醉药物。所有患者均在使用偏头痛预防性药物后症状好转。结论成人AM是一种少见疾病。对于不明原因、反复发作的中重度腹痛患者,如伴有头痛、偏头痛个人史或家族史,应想到AM的可能。尽早确诊和规范的偏头痛预防治疗可改善患者预后。

Objective To analyze the clinical characteristics of adult abdominal migraine(AM),and improve the understanding and the accuracy of diagnosis of this disease.Methods A case of adult AM diagnosed in the First Affiliated Hospital of Zhengzhou University in October 2019 was reported,and patients diagnosed with AM in the medical literature from January 2004 to May 2020 were searched and summarized.Results A total of 634 articles were retrieved,among which 14 articles reported 17 adult AM patients,totally 18 adult AM patients(11 females),including the case diagnosed in the First Affiliated Hospital of Zhengzhou University.Only two cases were diagnosed within one year after the onset,and the other cases were diagnosed several years later,of which the longest diagnostic delay was 37 years.The location and nature of abdominal pain were diverse.The median frequency of episodes was 2.5 times per month.Sixteen patients had a duration of 2-72 hours per attack,and the longest one lasted for four days.Fourteen patients had nausea,13 had vomiting,and seven had headache.Fifteen patients had a personal or family history of migraine.Sixteen patients′episodes were separated by weeks to months.Because nonsteroidal anti-inflammatory drugs were not beneficial to adults with AM,abortive triptan therapy was recommended and anesthetics were considered when necessary.All patients responded to prophylactic migraine therapies.Conclusions Adult AM is a rare disease.Patients with unexplained,recurrent and moderate to severe abdominal pain,combined with headache,a personal or family history of migraine,are highly suspected of having AM.Early diagnosis and prophylactic migraine therapies could contribute to good prognosis.