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It is necessary to state, at the very outset, that headache is never the sole symptom of a migraine, nor indeed is it a necessary feature of migraine attacks.
We shall have occasion to consider many types of attack which exhibit every characteristic of migraines—clinically, physiologically, pharmacologically, and otherwise—but lack a headache component.
We must retain the word migraine in view of its long and customary usage, but allow its extension far beyond the lim...
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We justify the use of the term “migraine equivalent” if the following circumstances are fulfilled: the occurrence of discrete non-cephalgic attacks with a duration, a periodicity, and a clinical format similar to attacks of common migraine, and a tendency to be precipitated by the same type of emotional and physical antecedents.
The physician who presumes to diagnose an “abdominal migraine” will be regarded, by many of his colleagues, as talking mumbo-jumbo or worse, and it may only be after endless diagnostic investigations and negative laparotomies, or the sudden replacement of attacks of abdominal pain by typical vascular headaches, that the old Victorian term is exhumed and reconsidered.
The concentrated experience of working with migraine patients must convince the physician, whatever his previous beliefs, that many patients do suffer repeated, discrete, paroxysmal attacks of abdominal pain, chest pain, fever, etc., which fulfil every clinical criterion of migraine save for the presence of headache.
