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Abdominal Migraine: Symptoms, Diagnosis, Causes, Treatment

Abdominal migraines aren't headaches. As their name suggests, they make your belly ache instead. But they often happen as a reaction to the same triggers as migraine headaches. They can hurt a lot and cause nausea, cramps, and often vomiting.

An 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 migraines, as links have been made to other family members having migraines and children who have this disorder often grow into adults with migraines. 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.

Of all kids who have chronic stomach pain, up to 15% of them may have abdominal migraines.; they're rare in adults. More girls get them than boys.

It has been estimated that up to 2% of all children may develop abdominal migraines.

An abdominal migraine can easily be confused with other, more common causes of stomachaches in children, such as irritable bowel syndrome (IBS) and Crohn´s disease.

Causes and Triggers

We don't know their exact cause. It could share some of the same risk factors as migraine headaches.

One theory is that changes in the levels of two compounds your body makes, histamine and serotonin, are responsible. Experts think that being upset or worried can affect them.

Foods such as chocolate, Chinese food with monosodium glutamate (MSG), and processed meats with nitrites might trigger abdominal migraines in some people.

Swallowing a lot of air may also trigger them or set off similar tummy symptoms. It can cause bloating and trouble eating.

One of the theories is that abdominal migraines stem from a problem in the connection between the brain and the GI tract. One very small study also found a link between this condition and slower movement of digested food through the intestines.

Abdominal migraines are more common in children who have close relatives with migraine headaches. One study found that more than 90 percent of kids with this condition had a parent or sibling with migraines.

Certain factors seem to trigger abdominal migraines, including stress and excitement. Emotional changes might lead to the release of chemicals that set off migraine symptoms.

Other possible triggers include:

  • exhaustion
  • motion sickness

Symptoms

Woman suffers from migraine

It will hurt in the center of your child's body or around their belly button (not their sides), what doctors call midline abdominal pain. Your little one could also:

  • Feel queasy or throw up
  • Be pale or flushed
  • Yawn, be drowsy or have little energy
  • Lose their appetite or be unable to eat
  • Have dark shadows under their eyes 
  • Cramping, nausea, and vomiting can accompany the pain. 
  • Pallor (paleness) of the skin is often observed
  • Appetite loss

Abdominal migraines are often sudden and quite severe. They can hit without any warning signs. The pain may go away after an hour, or it may last as long as 3 days. The symptoms are usually relieved by sleep. 

Each migraine attack lasts between one hour and three days. In between attacks, kids are healthy and have no symptoms.

The symptoms of an abdominal migraine are similar to those of many other childhood gastrointestinal (GI) conditions — that is, those involving the digestive system. The difference is that abdominal migraine symptoms come and go with days to months of no symptoms. Also, each episode of abdominal pain is very similar.

Diagnosis

As with any form of migraine, there is no diagnostic test to confirm abdominal migraines. Diagnosis is achieved by reviewing family and patient medical history, physical examination and performing investigations to rule out other causes of the symptoms.

Examples of other conditions that should be ruled out to arrive at a diagnosis of abdominal migraine include urogenital disorders, kidney disorders, peptic ulcer, cholecystitis (gall bladder), bowel obstruction, gastroesophageal reflux, Crohn’s disease, and irritable bowel syndrome. If there is any alteration in consciousness, seizure disorders should also be ruled out.

It can be hard to diagnose them because kids have trouble telling the difference between an abdominal migraine and ordinary stomachaches, stomach flu, or other problems with their belly and guts.

Because abdominal migraines tend to run in families, the doctor will ask about relatives who have migraine headaches.

Because of the frequent absence of headache, the condition can be difficult to diagnose, especially during the first episode. There is no specific test that can establish the diagnosis of abdominal migraine, so the diagnosis is based on the exclusion of other conditions. Laboratory tests and imaging studies are usually directed to rule out other conditions that could be responsible for the symptoms. Electroencephalography (EEG) is sometimes done to rule out a seizure disorder as the cause of the symptoms.

The doctor will also perform a physical exam.

Though usually ruled out by your child’s history and physical exam, tests such as ultrasound or endoscopy can be done to look for conditions that have similar symptoms.

Treatment

Man holding his face

Sometimes, simply knowing what the problem is, makes it easier to deal with.

Because we don't know much about abdominal migraines, doctors may treat them like other migraines. But they usually don't prescribe drugs unless the symptoms are very bad or happen a lot.

Medications like rizatriptan and sumatriptan, called triptans, haven't been approved for children, though older kids may have luck taking sumatriptan as a nasal spray.

Types of medications that may be used in adults to manage abdominal migraine include:

  • Analgesic drugs, such as nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen
  • Members of the triptan class of drugs used to treat migraine in adults have been used to treat some older children with abdominal migraine
  • Antidepressants and drugs that block the effects of serotonin have been used in some patients to decrease the frequency of attacks.
  • Ergotamine medications, also used for adults with migraine, are used to treat some childhood variants of migraine.
  • Low dose aspirin and low dose beta-blocker medications have been used over the long term in some patients in an attempt to diminish the frequency of future attacks.
  • The antihistamine cyproheptadine has been shown to be effective in some children with migraine variants.

Other aspects of treatment may include the administration of intravenous fluids if vomiting is severe, and the use of sedatives or antiemetic drugs.

Treatment may also include advice to recognize and avoid triggers if these are known. For example, if food triggers have been identified, these should be avoided, although not all those who experience abdominal migraines have identifiable food triggers. Stress management and relaxation programs may be of benefit to some.

Be sure your child is getting enough sleep, eating regular meals throughout the day, and drinking plenty of fluids (without caffeine).

If your child is vomiting, give them extra fluids to prevent dehydration.

Cognitive-behavioral therapy (CBT) can help relieve stress, which is thought to be another cause of abdominal migraines.

Prevention

With their parents' and doctor's help, kids with abdominal migraines may be able to figure out what triggers them. Keep a diary: Note the date and time they get it, what foods they had eaten earlier, what they were doing before it happened, if they took any medication recently, and if there's anything going on in their lives that could be making them stressed or anxious.

If food triggers abdominal migraines, they can try to avoid eating it. But that may not work for everyone.

Kids who have abdominal migraines should eat a nutritious diet with plenty of fiber. Other healthy habits, like daily exercise and getting enough sleep, and teaching them how to manage their emotions and deal with problems, can help, too.

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.

Concerns of abdominal migraines

Although the pain will come and go, it is severely debilitating during a migraine episode and can cause children to miss a significant amount of school over time. Children could be subjected to unnecessary surgery if the condition is misdiagnosed.

Talk to your pediatrician if your child is experiencing belly pain that is severe enough to disrupt normal activities.

Living with Abdominal Migraines

As children become teenagers, their migraine pain might move from the belly to the head as they develop more typical migraine headaches.

Follow your doctor’s advice on how to best prevent and treat migraines and try to avoid your child’s migraine triggers whenever possible.

Kids usually grow out of abdominal migraines within a year or two. However, up to 70% of these children will go on to develop migraine headaches when they grow up. Some will also experience abdominal pain in adulthood.

People suspected of having abdominal migraines should be carefully assessed by their doctor for an underlying cause as certain gastrointestinal, urogenital or metabolic conditions may mimic abdominal migraines.

 

Compiled using information from the following sources:

Top of Form

https://americanmigrainefoundation.org/resource-library/abdominal-migraine/

https://www.webmd.com/migraines-headaches/abdominal-migraines-children-adults#1

https://www.medicinenet.com/abdominal_migraines_in_children_and_adults/article.htm#what_is_the_prognosis_for_abdominal_migraine

https://www.healthline.com/health/abdominal-migraine

https://chw.org/medical-care/gastroenterology-liver-and-nutrition-program/conditions/abdominal-migraine

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