title: Migraineurs Initially Visiting the Gastroenterology Department.
abstract: OBJECTIVE
  Migraine-related nausea and vomiting are usually associated with severe and debilitating headache. However, there are unique headache patients with a chief complaint of prominent gastrointestinal (GI) discomfort, instead of headache. We sought to investigate distinctive characteristics and clinical outcomes of such patients, compared to migraine patients initially visiting headache clinic.
  
  
  METHODS
  This was a retrospective case-control study using a headache registry from April 2012 to December 2013. Case subjects were defined as patients who had first visited the gastroenterology clinic with chief complaint of nausea and/or vomiting, but then referred to the headache clinic for evaluation and management of concurrent headache. They were 1:2 matched to control subjects who met the migraine criteria based on propensity scores adjusted for age, sex, aura, headache frequency, and headache intensity.
  
  
  RESULTS
  We identified 51 case subjects, of which 80.4% were compatible with the migraine criteria. In multivariate testing, the case subjects were inversely associated with family history of headache (odds ratios [OR]: 0.36, 95% confidence interval [CI]: 0.13-0.99), alcohol drinking (OR: 0.18, 95% CI: 0.05-0.69), and aggravation by physical activity (OR: 0.19, 95% CI: 0.08-0.43). The proportions of subjects with a favorable clinical outcome in migraine management did not differ between the case and control groups (82.2% vs 79.1%, P = .670).
  
  
  CONCLUSIONS
  Primary symptoms of the case subjects had been GI; however, migraine management was most effective in relieving both prominent GI discomfort and headache. Our findings suggest that physicians should consider and investigate for the presence of migraine in patients with prominent GI symptoms and concurrent headache.
authors.affiliation: Department of Neurology, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea.|Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Kim
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chin-Sang
authors.initials: CS
authors.lastname: Chung
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Chung-Bin
authors.initials: CB
authors.lastname: Lee
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Poong-Lyul
authors.initials: PL
authors.lastname: Rhee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005762:Gastroenterology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000150:complications* / Q000175:diagnosis*; D009325:Nausea / Q000209:etiology*; D012042:Registries; D012189:Retrospective Studies; D014839:Vomiting / Q000209:etiology*; D055815:Young Adult
keywords: gastrointestinal; headache; migraine; nausea; vomiting