Abdominal Migraine
What is abdominal migraine?
Abdominal migraine is a type of childhood migraine variant which usually begins in school-aged children 4-7 years of age (See this post). It is described as recurrent bouts of moderate to severe “tummy” pain. The majority of patients report a family history of migraine. This condition is more commonly found in girls and may also occur in adults. Abdominal migraine is one of the most commonly diagnosed migraine variants.
How do you diagnose abdominal migraine?
Abdominal migraine is diagnosed in patients who report repeated attacks of moderate to severe “tummy” pain lasting from 2 hours to 3 days. Patients may experience a dull pain or occasional pain around the navel or middle of the “tummy” accompanied by nausea, vomiting, lack of color or loss of appetite. The patient reports feeling well and normal between episodes.
It is important to exclude other causes for these symptoms. Usually, a gastro-enterology investigation and opinion is part of the workup.
What worrisome symptoms do I watch out for?
Please see your doctor if you notice any of the following symptoms including but not limited to: change in weight or growth pattern, unexplained fever or rashes, pain radiating to the back, greenish vomitus, blood in stools, diarrhea for more than 2 weeks, ulcers in the mouth, painful or difficulty swallowing, joint pain and swelling, enlarged liver, difficulty urinating and/or a family history of inflammatory bowel disease.
What causes abdominal migraine?
The brain and the gut share some biological mechanisms for their function. Examples include serotonin and CGRP that are present and important in both systems. Immune factors may play a role as well. A migraine attack may be caused by a reaction to a stressor, and an abdominal attack might be a similar reaction from the gut. There is a lot of research ongoing.
What are the available treatments for abdominal migraine?
There is again very limited evidence regarding treatment for abdominal migraine.
The STRESS mnemonic has been proposed to help parents:
- S: stress management
- T: travel tips to help avoid triggers
- R: for rest, a very important aspect and part of treatment
- E: emergency signs like fever, weight loss, pain that awakes the child and difficulty swallowing, those should lead to an urgent evaluation. A child with abdominal migraine can still have another gut problem.
- S: sparkling lights can trigger episodes, a phenomenon seen in people with migraine with aura as well
- S: healthy snacks are important as fasting is a trigger; some foods might be triggers (processed meats, glutamate, caffeine etc)
Patients should see their family doctor to discuss possible treatments, such as nasal spray migraine medications (ex. Sumatriptan). Preventive treatments such as Pizotifen and/or Flunarizine may be considered for patients experiencing frequent, prolonged and disabling attacks.
Will I or my child suffer from this condition forever?
Although this condition may persist at later age, around 60% of patients report a resolution of symptoms during teenage years or early adulthood.
Around 70% of patients may develop migraine headaches in the future.
REFERENCES:
Gelfand A. Episodic syndromes of childhood associated with migraine. Current Opinion Neurology.2018;31:281-285.
Lagman-Bartolome AM, Lay C. Pediatric Migraine Variants: A review of epidemiology, diagnosis, treatment and outcome. Current Neurology and Neuroscience.2015;12:1-14.
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