Abdominal Migraine

Abdominal migraine is a rare form of migraine found in children between the ages of 6-12. It is distinctly characterized by episodes of pain in the abdomen that occur along with other migraine symptoms. 

What Causes It?

Although abdominal migraine is still not fully understood, some theories say that disrupted signals between brain and gut can cause hypersensitivity in the digestive organs and perhaps predispose a child to abdominal pain. 

It is also not clear why children tend to get abdominal migraines rather than adults. However, what is known is that a child with a family history of abdominal migraine is most likely to get it as well, suggesting a genetic connection. That child is also more likely to develop more typical migraines as an adult.

What Are the Symptoms?

Symptoms of abdominal migraine can vary from child to child, but common symptoms can include pain in the central abdomen, lasting 1-to-72 hours and severe enough to disrupt normal activity. The child may also have nausea and vomiting, loss of appetite, and pale skin. These symptoms rarely occur between episodes of migraine. 

Some of the more recognized symptoms of migraine may also occur, although in milder form in children than they do in adults. These may include severe, throbbing headache, usually on one side of the head, and sensitivity to light, smell, and noise.

How Is It Diagnosed?

There are no specific tests available to diagnose abdominal migraine. The physician evaluates the type, intensity, and frequency of symptoms, and will first attempt to rule out other common causes of abdominal pain in children and early teens.

How Is It Treated?

To help bring relief to a young person experiencing abdominal migraine, a recommended first approach is to prescribe simple analgesics (paracetamol, ibuprofen) or intranasal sumatriptan and have the child rest in a dark, quiet room.

Where a more aggressive approach is needed, the physician may prescribe pizotifen, taken twice daily as a syrup.  

Children with abdominal migraine usually recover quite well, with no neurological or developmental deficits. In a study of 54 school-aged children, abdominal migraine proved to be resolved in over 60% of the kids, 8-to-10 years later. 

Is It Preventable?

In severe cases of abdominal migraine, the treating doctor may prescribe a daily preventive medication, including pizotifen (serotonin agonist) syrup, propranolol (β blocker), cyproheptadine (antihistamine) syrup, or flunarizine (calcium channel blocker).

What Causes It?

Although abdominal migraine is still not fully understood, some theories say that disrupted signals between brain and gut can cause hypersensitivity in the digestive organs and perhaps predispose a child to abdominal pain. 

It is also not clear why children tend to get abdominal migraines rather than adults. However, what is known is that a child with a family history of abdominal migraine is most likely to get it as well, suggesting a genetic connection. That child is also more likely to develop more typical migraines as an adult.

What Are the Symptoms?

Symptoms of abdominal migraine can vary from child to child, but common symptoms can include pain in the central abdomen, lasting 1-to-72 hours and severe enough to disrupt normal activity. The child may also have nausea and vomiting, loss of appetite, and pale skin. These symptoms rarely occur between episodes of migraine. 

Some of the more recognized symptoms of migraine may also occur, although in milder form in children than they do in adults. These may include severe, throbbing headache, usually on one side of the head, and sensitivity to light, smell, and noise.

How Is It Diagnosed?

There are no specific tests available to diagnose abdominal migraine. The physician evaluates the type, intensity, and frequency of symptoms, and will first attempt to rule out other common causes of abdominal pain in children and early teens.

How Is It Treated?

To help bring relief to a young person experiencing abdominal migraine, a recommended first approach is to prescribe simple analgesics (paracetamol, ibuprofen) or intranasal sumatriptan and have the child rest in a dark, quiet room.

Where a more aggressive approach is needed, the physician may prescribe pizotifen, taken twice daily as a syrup.  

Children with abdominal migraine usually recover quite well, with no neurological or developmental deficits. In a study of 54 school-aged children, abdominal migraine proved to be resolved in over 60% of the kids, 8-to-10 years later. 

Is It Preventable?

In severe cases of abdominal migraine, the treating doctor may prescribe a daily preventive medication, including pizotifen (serotonin agonist) syrup, propranolol (β blocker), cyproheptadine (antihistamine) syrup, or flunarizine (calcium channel blocker).

Sources
  1. The BMJ. Abdominal migraine. https://www.bmj.com/content/360/bmj.k179.full
  2. Nature Review: Gastroenterology and Hepatology..Childhood functional abdominal pain: mechanisms and management. https://pubmed.ncbi.nlm.nih.gov/25666642/
  3. Internal Medicine. Abdominal Migraine in a Middle-aged Woman. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088539/
  4. Molecular Genetics and Genomics. Ion channelopathies and migraine pathogenesis. https://pubmed.ncbi.nlm.nih.gov/28389699/
  5. Cephalalgia. Is there a place for "abdominal migraine" as a separate entity in the IHS classification? Yes! https://pubmed.ncbi.nlm.nih.gov/1473133/
  6. Archives of Disease in Childhood. Prevalence and clinical features of abdominal migraine compared with those of migraine headache. https://adc.bmj.com/content/72/5/413?ijkey=09b4b0103bcd7a7a6be6cdf443aac27eb42312c0&keytype2=tf_ipsecsha
  7. Nature. The relationship between abdominal pain and emotional well-being in children and adolescents in the Raine Study. https://www.nature.com/articles/s41598-020-58543-0
  8. BMJ Journals. Archives of Disease in Childhood. Double-blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine.. https://adc.bmj.com/content/72/1/48?ijkey=4d13d5fe4875d0a195cf2ac560ecbb7abe448342&keytype2=tf_ipsecsh
  9. BMJ Journals. The prognosis of childhood abdominal migraine. https://adc.bmj.com/content/84/5/415?ijkey=b62313b25b0be9140ba64c87cba427b5484a3bc4&keytype2=tf_ipsecsha

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