Abdominal migraine is a form of migraine seen mainly in children. It is most common in children ages five to nine years old, but can occur in adults as well. Abdominal migraine consists primarily of abdominal pain, nausea and vomiting.
It is recognized as an episodic syndrome that may be associated with migraine, as links have been made to other family members having migraines and children who have this disorder often grow into adults with migraine. Most children who experience abdominal migraine grow out of it by their teens and eventually develop migraine headaches.
The pain associated with abdominal migraine is generally located in the middle of the abdomen around the belly button. It is often described as dull or “just sore” and may be moderate to severe. In addition to the pain, there can be loss of appetite, nausea, vomiting and pallor. The attacks last between 2-72 hours and in between attacks there should be complete symptom freedom.
Abdominal migraines can cause severe stomach pain, nausea, abdominal cramping, and vomiting.
Facts about abdominal migraine in children
Some studies estimate 1 percent to 4 percent of children suffer from abdominal migraine; while others say that about 10 percent of children experience recurrent abdominal pain at some point in childhood
- Children with abdominal migraine usually have a family history of migraine
- 65 percent of cases of abdominal migraine or cyclic vomiting had a family migraine history (from a study of 5,848 patients in a pediatric neurology practice)
- Patients with abdominal migraine usually have them go away on their own within two years
- Females have abdominal migraines more often than men
- About half of the people who have abdominal migraine also have migraine attacks with head pain
- One study showed that only 1.5 percent of people who suffered from abdominal migraine as children continued to experience stomach pain during migraine attacks as adults
- Another study showed that in seven to 10 years after children were diagnosed with abdominal migraine, 61 percent had absolutely no abdominal migraine symptoms
- Children with abdominal migraine are more likely to have psychiatric issues, such as anxiety as adults
- Children with abdominal migraine more often have a mother with migraine than those with migraines that cause head pain
Diagnosing abdominal migraines is difficult. Children have difficulty distinguishing the features of an abdominal migraine from an upset stomach or other gastrointestinal illnesses.
Family history of migraine and abdominal migraines is a key factor in determining the possibility of abdominal migraines. So the doctor will look at the patient’s family medical history to assist in making an accurate diagnosis.
The first step is to eliminate other causes of stomach pain. Then the doctor may assess specific criteria developed by migraine experts. To determine the likelihood of an abdominal migraine, the doctor may check for some of the following symptoms:
- Moderate to severe midline pain lasting from 1 to 72 hours
- Symptoms of nausea and vomiting
- Anorexia – a decrease in appetite, inability to eat
- Yawning, listlessness, drowsiness
- Pallor – paleness/abnormally pale skin colour
- Dark shadows under the eyes
For acute treatment of abdominal migraine attacks, medications used for other forms of migraine are often employed. These include hydration therapy (particularly if there has been significant vomiting), NSAIDs, antinausea medication and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal migraines are frequent, preventive therapies used for other forms of migraines can be explored. These include pizotifen, flunarazine, propranolol, cyproheptadine and topiramate.
What are the signs and symptoms of abdominal migraines?
Symptoms of abdominal migraines may include:
- Acute, severe, midline abdominal pain that is associated with nausea
- Inability to eat
- The abdominal pain may last for one hour or up to three days.
Migraine headaches are sometimes preceded by an aura, a symptom that can alert the person that a headache is coming on. However, abdominal migraines are frequently sudden and quite severe. They can occur without any warning signs and this can increase anxiety in the person who gets them.
How are abdominal migraines treated?
A specific treatment for abdominal migraines has not yet been established. Because little is known about treating abdominal migraines, doctors may treat them like other migraines.
For some patients certain serotonin blockers and tricyclic antidepressants may be useful for treating abdominal migraines.
Triptans may also help adults with abdominal migraines. Valproic acid, which is used to treat migraine headaches, has been used with some success in treating abdominal migraines.
Adult abdominal migraine
Abdominal migraine isn’t often diagnosed in adults. Therefore, when adult men and women experience the symptoms other syndromes or disorders are considered first, such as irritable bowel syndrome, reflux or lactose intolerance. As with other types of migraine, doctors typically rule out other disorders before diagnosing migraines. Sometimes it takes years for to correctly diagnose abdominal migraine in adults.
- Abdominal migraine triggers
- Stress, positive or negative stress such as excitement before a family trip or worry over a school test
- Car sickness
- Fasting and skipping meals
- Changes in sleep patterns
- Exposure to flickering, glaring or bright lights
- Exercise causes flare ups in some people
- Certain foods trigger abdominal migraines such as:
- Citrus fruits
- Chinese foods, particularly if it contains monosodium glutamate, MSG
- Preserved meats such as hot dogs and sausages
As with all types of migraine, it is important to keep a migraine journal to record the how often symptoms occur, how long they last and to discover your own triggers.
Who Gets Abdominal Migraine?
Anyone with a tendency towards classic migraine could get abdominal migraine, but it is more common in children than adults. Children whose parents have migraine are more likely to develop the abdominal variant, and are more likely to have migraine headaches as they grow into adults. It is estimated that around 2% of children have abdominal migraines, with girls being more susceptible than boys. The condition usually appears for the first time between the ages of two and 10 years.
Abdominal migraine can be preceded by aura with similar symptoms to those present in migraine headaches. They can include vomiting and nausea, along with photophobia, a heightened sensitivity to light.
Sufferers of classic migraine headaches are often advised to keep a migraine diary, and this is effective in figuring out what causes abdominal migraines too.
Even older children will need help to get going with a diary, and ongoing help to keep it up. For younger ones, parents do it for them. When you’re keeping a migraine diary, things to note include:
- When the attack started – date and time.
- What foods children had eaten before the attack.
- What activities they were involved in.
- What medication they were taking.
- Current worrying situations or anxiety they’re feeling.
- What you did to help the pain previously, and if it worked.
- How long the attack lasted.
Over time, the answers to those questions help you identify patterns and triggers, making it easier to avoid migraine-causing conditions and situations in the future.
Having a healthy lifestyle is also thought to help prevent attacks, and this includes getting daily exercise, having regular sleeping patterns (even at weekends or on vacation), eating nutritious food as part of a balanced diet and learning coping strategies for stressful situations.
If your child gets frequent stomachaches, it could be they’re suffering from abdominal migraine. Adopting some of the prevention and coping strategies for classic migraine could provide the missing link that helps decrease the frequency and severity of their episodes.
Complications of abdominal migraines
Abdominal migraines can be severe enough to keep children out of school for a few days at a time. Because this condition is easy to mistake for other GI diseases, kids who are misdiagnosed may end up undergoing unnecessary procedures.
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