A pediatric neurologist explains what abdominal migraine is, its symptoms and how to treat it.
Abdominal migraine is a form of migraine with abdominal pain, nausea, and vomiting episodes. It’s different from typical migraine attacks because it doesn’t usually have head pain as a symptom. This disease is mostly seen in children. Attacks can last from two to 72 hours, and in between attacks, a person has no symptoms.
To help parents who may see these symptoms in their children, we spoke with Dr. Kaitlin Greene, a pediatric neurologist and director of the Child and Adolescent Headache Program at Doernbecher Children’s Hospital at Oregon Health & Science University in Portland, Oregon. She shared the symptoms of abdominal migraine and how to recognize and treat it.
Signs and Symptoms of Abdominal Migraine
The pain connected to abdominal migraine is generally located in the middle of the stomach around the belly button. It can feel like a dull ache or soreness and may be moderate to severe. In addition, loss of appetite, nausea, vomiting, and a pale appearance (pallor) can occur. Some children also have other migraine symptoms, like light and noise sensitivity.
This type of migraine is mainly seen in children, most commonly under 10 years old, but it can also affect adults. The average age for onset (start of symptoms) is seven years old. The disease affects 1 to 4% of school-aged children and tends to affect more girls than boys. “Children with abdominal migraine usually start to outgrow the abdominal pain symptoms sometime around puberty,” says Dr. Greene. According to research, about 60% of children with this disease no longer have episodes of abdominal pain by their late teenage years.
However, many of these children go on to develop typical migraine. “The majority of patients with abdominal migraine—somewhere between 50% and even up to 70% of patients in one study—either have migraine that occurs at the same time that they have abdominal migraine or they then develop it later in the adolescent or teenage years,” says Dr. Greene.
How To Diagnose Abdominal Migraine
Abdominal migraine is hard to diagnose and many people are diagnosed years after their symptoms start. “When people are diagnosed with abdominal migraine, the average length of time that they’ve gone with symptoms before getting diagnosed is reported as two years. ” says Dr. Greene. Abdominal pain can be common in childhood, and children may have trouble describing their pain and communicating the difference between these symptoms and a typical stomachache. “We always say that migraine is not just a headache. Abdominal migraine is also not just a stomachache,” says Dr. Greene.
Like other forms of migraine, there is no diagnostic test (like a blood test or scan) for abdominal migraine. Children with family members who have migraine are more likely to have this disease, so knowing your family history can help get a diagnosis. Your doctor will review a family and patient medical history, do a physical examination and perform tests, like an abdominal ultrasound or X-ray, to rule out other causes for the abdominal pain.
For example, they will likely want to rule out conditions that have similar symptoms to this disease. This may include ulcers, disorders involving the bladder, reproductive system and kidneys, Crohn’s disease and irritable bowel syndrome.
Abdominal Migraine Triggers
It’s not clear what causes abdominal migraine. For many, the attacks happen without warning, so it can be hard to avoid triggers. However, some people may recognize factors that seem to lead to an attack.
“For some children, certain foods can trigger abdominal migraine—though, in studies, food triggers seem to be actually less common than they are for even migraine,” says Dr. Greene. She says stress, poor sleep, travel, motion sickness and missing a meal are common triggers. Tracking symptoms over time can help narrow down possible triggers.
Treatment Options for Abdominal Migraine
Medications used for other forms of migraine can also help treat abdominal migraine when symptoms start. Acute treatment options include non-steroidal anti-inflammatory drugs (NSAIDs), anti-nausea medications, and triptans. “Many people will try oral analgesics [pain relievers] like Tylenol or ibuprofen,” says Dr. Greene. “Taking rest and lying in a dark, quiet place can be helpful.”
Hydration therapy (fluids delivered through a small IV) may be used when a person has been vomiting often or over a longer period of time. If abdominal migraine attacks happen frequently, your doctor may want to try a preventive treatment, such as medication, supplements, cognitive behavioral therapy and dietary modifications.
As for any form of migraine, lifestyle changes can help prevent migraine attacks. Getting enough sleep on a regular schedule, eating regular nutritious meals, drinking enough water, exercising and managing stress support a healthy lifestyle.
Nothing hurts more than to see your child in pain. It is vital to believe them and advocate for their health. Speak with your child’s doctor about their symptoms, share any family history and bring up abdominal migraine as a possible diagnosis. In time, you’ll find the best way to treat and prevent future attacks.
The American Migraine Foundation is committed to improving the lives of those living with this debilitating disease. For more of the latest news and information on migraine in children, visit the AMF’s Pediatric Migraine Content Hub. For help finding a healthcare provider, check out our Find a Doctor tool. Together, we are as relentless as migraine.