Abdominal Migraine

The Basics

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

Please refer to the International Classification of Headache Disorders 3rd edition (beta version) website for more information on the criteria used to diagnosis abdominal migraine: https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/

Diagnosis

As with any form of migraine, there is no diagnostic test to confirm abdominal migraine. 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.

Treatment

For acute treatment of abdominal migraine attacks, medications used for other forms of migraine are often employed. These include hydration therapy (particularly if there has been significant vomiting), NSAIDs, antinausea medication and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal migraines are frequent, preventive therapies used for other forms of migraines can be explored. These include pizotifen, flunarazine, propranolol, cyproheptadine and topiramate.

Summary

Abdominal migraine is a sub-type of migraine seen mainly in children. It consists of episodes of abdominal pain with nausea, vomiting, loss of appetite or pallor. Between episodes, there should be no symptoms. Children with abdominal migraine generally go on to develop migraine headaches later in life. People suspected of having abdominal migraine should be carefully assessed by their doctor for an underlying cause as certain gastrointestinal, urogenital or metabolic conditions may mimic abdominal migraine.

Resources:

The International Headache Society. https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/

Gelfand AA. Episodic syndromes that may be associated with migraine: A.K.A. “the childhood periodic syndromes”. Headache. 2015;55(10):1358-1364.

Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53(6):984-993.