Department of Pediatrics, Tohoku University School of Medicine.
Tohoku J Exp Med. 2010 May;221(1):49-51. doi: 10.1620/tjem.221.49.
Abdominal migraine is one subcategory of migraine-related syndromes. Migraine is sometimes associated with facial ecchymosis, which may be accounted for by trigeminovascular activation. However, the precise mechanism of this concurrence remains unknown. Here, we describe a 9-year-old girl, who presented ecchymosis of the legs and buttock associated with recurrent, severe, non-localized midline abdominal pain. The patient has positive family history of migraine. Investigations during an attack revealed no obvious abnormalities. According to the International Classification of Headache Disorders (Second Edition), she was diagnosed with abdominal migraine. Her abdominal pain was relieved with sumatriptan, a migraine-specific serotonin(1B/1D) agonist. The ecchymosis always occurred in conjunction with abdominal pain and tended to regress after pain relief. In contrast to the local trigeminovascular activation theory that explains the ecchymosis in a migraine-related condition, the findings gained from the presented patient suggest a mechanism that involves the initial activation of the visceral nerves responsible for abdominal nociception under the predisposition of visceral hypersensitivity associated with abdominal migraine. Subsequently, ecchymosis developed in the skin region innerved by the activated nerves, possibly involving dichotomizing afferent fibers and afferent-afferent interactions via sacral spinal cord pathway or a sympathetic reflex. Taken together with the probable common mechanism of migraine and abdominal migraine, we suggest that the skin changes in migraine are associated with somatic referral of migraine headache via the trigeminal nerve pathway.
腹型偏头痛是偏头痛相关综合征的一个亚类。偏头痛有时与面部瘀斑有关，这可能是三叉血管激活所致。然而，这种并存的确切机制尚不清楚。在这里，我们描述了一名 9 岁女孩，她出现腿部和臀部瘀斑，并伴有反复发作、严重、非局限性中线腹痛。该患者有偏头痛的阳性家族史。发作期间的检查未发现明显异常。根据国际头痛疾病分类（第二版），她被诊断为腹型偏头痛。她的腹痛用曲坦类药物（一种偏头痛特异性血清素（1B/1D）激动剂）缓解。瘀斑总是与腹痛同时发生，并在疼痛缓解后消退。与解释偏头痛相关病症中瘀斑的局部三叉血管激活理论相反，从所介绍的患者中获得的发现表明，在与腹型偏头痛相关的内脏感觉过敏倾向下，涉及负责腹痛感觉的内脏神经的初始激活的机制。随后，在受激活神经支配的皮肤区域出现瘀斑，可能涉及通过骶髓途径或交感反射的二分传入纤维和传入-传入相互作用。结合偏头痛和腹型偏头痛的可能共同机制，我们建议偏头痛的皮肤变化与偏头痛头痛通过三叉神经通路的躯体牵涉有关。
