159: Dihydroergotamine in Cyclic Vomiting Syndrome and Abdominal Migraine

Topic: Clinical Science
Subtopic:

Background and Aims: Abdominal migraines and cyclic vomiting syndrome (CVS) can present with debilitating symptoms in the pediatric and young adult population. At the Children’s Hospital of Richmond, intravenous dihydroergotamine (DHE) is utilized as a treatment for refractory abdominal migraine and CVS. This IRB-approved, retrospective case series describes the response of 16 patients who received DHE treatment for abdominal migraine, CVS, or chronic migraines associated with nausea from 2023-2025.

Methods: A chart review of the Autonomic Registry showed that 13 of the patients had recurring abdominal migraines, and 4 of them had a co-diagnosis of CVS. The other 3 patients had chronic headaches associated with intractable nausea or vomiting. Patient ages ranged from 8 to 28 years old with 5 males and 11 females, the majority of whom were pediatric. The most common co-morbidities were postural tachycardia syndrome (POTS), gastroparesis, functional neurologic disorder, and irritable bowel syndrome (IBS). Associated symptoms include nausea, dizziness, and photophobia/phonophobia. Most patients have had either daily or weekly symptoms for at least one year.

Results: Nine out of the 16 patients responded well to the DHE infusion without significant side effects and exhibited improvement in their symptoms afterwards. Symptom improvement occurred within 10 days of the infusion, with patients exhibiting decreased abdominal pain, nausea, or headache frequency as well as general functional improvement.

Conclusions: Based on this case series, DHE may be a viable treatment option for those with refractory abdominal migraine or cyclical vomiting syndrome. Furthermore, the resolution of intractable abdominal pain along with chronic nausea/vomiting suggests that abdominal migraines could be chronic in nature. Abdominal migraine is accepted to be episodic in nature; however, other migraine disorders such as migraine headaches can transition from episodic migraine to chronic migraine based on the frequency of episodes each month. Thus, this case series supports the notion that the criteria for abdominal migraine should be revised to include a diagnosis of chronic abdominal migraine.

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Presenting Author: Gisela Chelimsky
Submitting Author: Brianna Dinn

Senior Author: Gisela Chelimsky

IASP 2026 Global Year theme of Neuropathic Pain: No

• Gisela Chelimsky: MD - Virginia Commonwealth University
• Mary Holthaus: MSPAS - Virginia Commonwealth University
• Bhakti Dave: MPH - Virginia Commonwealth University