Adult Abdominal Migraine Responding to Ketamine Infusion: A Case Report

Case Diagnosis: A 59-year-old female with a 15-year history of episodic, severe abdominal pain.

Case Description or Program Description: This patient presented to the emergency department with acute onset diffuse abdominal pain described as a severe “twisting” sensation, rated at a 9/10 intensity. She reported that the pain was consistent with her previous abdominal migraine flares but significantly more severe.
On examination, the patient reported moderate discomfort with significant sleep disruption due to inadequate pain control. Urinalysis was suggestive of a urinary tract infection (UTI) and the patient was started on empiric ceftriaxone. Her initial pain regimen included fentanyl IV push, however, given the patient’s refractory pain, alternative treatment options were discussed. The patient has previously taken sumatriptan, beta blockers, metoclopramide, and over-the-counter analgesics without pain relief. Given the patient’s comorbid bipolar disorder and functional neurologic symptom disorder, a trial of IV ketamine (0.2 mg/kg) was initiated with her consent.
Following ketamine administration, the patient reported significant pain relief and increased ability to ambulate. Given her positive response, fentanyl was discontinued, and her pain regimen was adjusted to scheduled Percocet 5-325 mg twice daily in accordance with her home regimen with as-needed oxycodone 5 mg every four hours. She remained hemodynamically stable throughout her stay, with no adverse effects from ketamine.

Setting: Tertiary care academic health center

Assessment/Results: The patient’s pain improved significantly after a ketamine infusion, enabling increased mobility and functional recovery.

Discussion (relevance): This case underscores the challenges of managing severe abdominal migraine flares and suggests that ketamine may be an effective option for pain refractory to conventional treatment.

Conclusions: A multimodal pain approach, including ketamine, may improve outcomes in patients with severe abdominal migraines, providing effective pain control and offering significant functional improvement.