Abstract Details

Title Cluster Belly: A Variant of Irritable Bowel Syndrome?

Topic Headache

Presentation(s) P01 - (-)

Poster/Presentation
Number 073

Objective

Background Cluster headache and irritable bowel syndrome (IBS) are pain disorders that possess relationships with circadian rhythms and derangements in the hypothalamus. However, they have not been compared to assess similarities that could yield pathophysiologic insights.

Design/Methods Case report.

Results A 30 year old man started experiencing episodes of abdominal pain at 6 years of age. Attacks consisted of moderate, crampy, diffuse abdominal pain episodes with flatulence, predictably triggered by greasy or creamy foods, particularly during times of stress, typically leading to diarrhea and relief after defecation. At 12 years of age he began to experience different, more severe attacks, featuring excruciating, searing, crampy, usually unilateral and lower abdominal pain, accompanied by diaphoresis and mild nausea. He usually felt extraordinarily restless during the episodes, possessing the urge to repeatedly bend over or pace during the attacks, which lasted 30 to 120 minutes, usually occurring between 3PM and 1AM. Attacks occurred in periods lasting 2 to 8 weeks, interspersed with remissions over months. Only during attack periods were triggers such as red wine and fried foods identified; these substances did not trigger pain outside of the attack periods. Defecation inconsistently provided relief. When he sought medical evaluation at 20 years of age examination was normal, and a gastroenterologist diagnosed IBS.

Conclusions Although all of the patient's symptoms may fall within the spectrum of IBS, the semiology of the recurrent abdominal pain attacks are reminiscent of cluster headache, based on the attack duration, restlessness, periodicity, and selective vulnerability to particular triggers only during attack periods. A subset of patients with IBS may feature similar attack profiles and could suggest the hypothalamus as the central attack generator, akin to cluster headache.

Authors/Disclosures
Matthew S. Robbins, MD, FAAN (Weill Cornell Medicine) PRESENTER	Dr. Robbins has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer. Dr. Robbins has received publishing royalties from a publication relating to health care. Dr. Robbins has a non-compensated relationship as a Board of Directors member, ��ɫ�� Program speaker with American Headache Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Board of Directors member, ��ɫ�� Program speaker with New York State Neurological Society that is relevant to AAN interests or activities. Dr. Robbins has a non-compensated relationship as a Editorial Board Member with Continuum, ��ɫ�� that is relevant to AAN interests or activities.
Michael R. Edwards, PhD (Ionis)	No disclosure on file

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