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Abdominal Migraines in Children and Adults: Get the Facts

Abdominal migraine in children facts

  • Abdominal migraine is believed to be a
    variant of migraine that is common in children but rare in adults.
  • Abdominal migraine is characterized by
    pain in the center of the abdomen that may be severe.
  • Symptoms can last for one hour or up to
    a several days.
  • Nausea and vomiting may be associated
    with the pain.
  • Sleep typically brings relief from
    abdominal migraine. Medications used to treat classic migraine can also be
    effective, although there is no single treatment that is known to be effective
    in all patients.
  • Most children with abdominal migraine
    have a family history of migraine, and most go on to develop migraine as adults.
  • The exact cause of abdominal migraine
    is poorly understood. It may be related to both neurologic and endocrinologic
    (hormone)
    factors.
  • The diagnosis of abdominal migraine can
    be difficult, and depends upon ruling out other potential causes for the
    abdominal pain and symptoms. There is no one diagnostic test that confirms the
    diagnosis.

What is abdominal migraine?

Like adults, children can develop migraines. This can be the same type of
condition seen in adults, which is typically occurs with a headache, and is
sometimes preceded by an aura. Nausea, vomiting, and photophobia (decreased
tolerance to light) can occur. Children also develop some unusual and atypical
variations of migraine, not associated with headaches in particular, that are
not usually observed in adults. Abdominal migraine is one of these variants.

Abdominal migraine is a condition thought to be related to migraine that is
characterized by pain in the abdomen. It is often precipitated by the usual
triggers of classic migraine. The pain can be severe, and nausea and vomiting
can occur.

Abdominal migraine is rare in adults, but it has been estimated that up to 2%
of all children may develop abdominal migraines. Children who have the condition
usually go on to develop migraine headaches as adults. Girls are affected more
frequently than boys. Abdominal migraine typically occurs for the first time
between the ages of 2 and 10.

What causes abdominal migraine?

The cause of abdominal migraine is poorly understood. Abdominal migraine is
thought by some researchers to be related to neurologic or endocrinologic
changes and may be caused by alterations in the levels of serotonin and
histamine in the body. Genetic factors may also be involved as the condition is
more common in children who have a family history of migraine. About 60% of
children with the condition have a positive family history for migraine.

Triggers for abdominal migraine have been described, similar to triggers for
classic migraine. These include chocolate or nitrite-containing foods, stress,
and anxiety.

What are the symptoms of abdominal migraine?

As mentioned, abdominal migraine causes pain in the abdomen that can be
severe and debilitating. It is typically located in the middle portion of the
belly, often around the umbilicus. Cramping, nausea, and vomiting can accompany
the pain. Pallor (paleness) of the skin is often observed. There may not be associated
headache. The symptoms are usually relieved by sleep and can last anywhere from
one hour to several days.

How is abdominal migraine diagnosed?

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
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.

What is the treatment for abdominal migraine?

The treatment of abdominal migraine has two components – to reduce symptoms
of an acute attack and to prevent or lessen the severity of future episodes.
Research to date has not provided sufficient data to firmly establish the role
of any particular medication in either treating symptoms or preventing future
episodes of abdominal migraine. Still, many patients respond to anti-migraine
medications and other medications.

Medications to treat abdominal migraine

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

  • Analgesic drugs, such as nonsteroidal
    anti-inflammatory medications (NSAIDs) or
    acetaminophen
  • Sumatriptan
    (Imitrex, Alsuma), a member of the triptan
    class of drugs used to treat migraine in adults, has been used to treat some
    older children with abdominal migraine
  • Tricyclic antidepressants and drugs
    that block the effects of serotonin have been used in some patients to decrease
    frequency of attacks.
  • Valproic acid (Depakote), an
    antiseizure medication, has been used to treat abdominal migraine.
  • 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 migraine have
identifiable food triggers. Stress management and relaxation programs may be of
benefit to some.

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What is the prognosis for abdominal migraine?

The prognosis for abdominal migraine is good; most children eventually stop
having the attacks of abdominal pain. However, most children (about 70% in one
study of 54 children) who have abdominal migraine go on to develop migraines in
adulthood.

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