Neurologic Etiology of Episodic Abdominal Pain: Epilepsy vs. Migraine

The temporal lobe has a vital role in epilepsy, and is the most common lobe involved in focal onset seizures. Patients with temporal lobe epilepsy (TLE) usually have auras, an epigastric-rising sensation is the most common aura reported. Semiology of TLE is abdominal pain. Thus, TLE has to be suspected in patients with unexplained episodic paroxysmal abdominal pain associated with symptoms such as loss or changing of consciousness, and migraine-like symptoms. This case reports a 14-year-old boy who has been diagnosed with abdominal migraine for 7 years. He initially presented with episodic severe abdominal pain and right-sided headache. The abdominal pain is periumbilical, and not associated with vomiting or diarrhea. There are no other gastrointestinal complaints, and all the abdominal investigations were negative. Drugs were of no significance on the long term. Recently, the patient was found to have a benign brain tumor, and correlation with an electroencephalography (EEG) that gave abnormal results due to the presence of bilateral spike-and-wave discharges confirmed the diagnosis of temporal lobe epilepsy manifested by abdominal pain. Our patient did not fulfill the International Classification of Headache Disorders Third Edition (Beta Version) (ICHD-IIIb) diagnostic criteria for abdominal migraine, although his case was reviewed by many physicians over the years. In conclusion, this case shows how important it is to follow the diagnostic criteria of diseases and disorders. It also focuses on how seizures can have a wide spectrum of manifestations. Thus, neurological causes have to always be on the differential diagnoses.