MIGRAINES - Abdominal Migraine

Abdominal Migraine - The Basics

by Teri Robert, Lead Expert

Abdominal Migraine is a form of Migraine seen mainly in children. It's 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 was recognized as a form of Migraine disease as links were made to other family members having Migraines and children who had this disorder grew into adults with Migraine with and without aura. Most children who experience abdominal Migraine eventually develop Migraine with aura and/or Migraine without aura. The diagnostic criteria for abdominal Migraine, as established by the International Headache Society, are:

A. At least 5 attacks fulfilling criteria B–D

B. Attacks of abdominal pain lasting 1-72 hours (untreated or unsuccessfully treated

C. Abdominal pain has all of the following characteristics:

·         midline location, periumbilical or poorly localised

·         dull or ‘just sore’ quality

·         moderate or severe intensity

During abdominal pain at least 2 of the following:

·         anorexia

·         nausea

·         vomiting

·         pallor

Not attributed to another disorder (1)

Note:
(1) In particular, history and physical examination do not show signs of gastrointestinal or renal disease or such disease has been ruled out by appropriate investigations.

Comments:
Pain is severe enough to interfere with normal daily activities. Children may find it difficult to distinguish anorexia from nausea. The pallor is often accompanied by dark shadows under the eyes. In a few patients flushing is the predominant vasomotor phenomenon. Most children with abdominal migraine will develop migraine headache later in life.

Diagnosis:

As with any form of Migraine, there is no diagnostic test to confirm abdominal Migraine. Diagnosis is achieved by reviewing both family and patient medical history, evaluating the symptoms, and performing an examination to rule out other causes of the symptoms. Other conditions that should be ruled out to arrive at a diagnosis of abdominal Migraine include: urogenital disorders, peptic ulcer, cholecystitis (gall bladder), duodenal obstruction, gastroesophageal reflux, Crohn's disease, and irritable bowel syndrome. If there is any alteration in consciousness, seizure disorders should also be ruled out.

Treatment:

For infrequent abdominal Migraine attacks, medications used for other forms of Migraine are often employed. These medications can include NSAIDs, antinausea medications, Midrin, and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal Migraines are frequent, the same preventive therapies used for other Migraines can be explored.