Why abdominal migraine is more than just a stomachache
Abdominal migraine is a sub-type of migraine where instead of having head pain, patients experience abdominal pain. Dr. Juliana VanderPluym, a pediatric neurologist at the Mayo Clinic in Phoenix, AZ says abdominal migraine is “another way that migraine can express itself in children.” Understanding the symptom and its link to migraine can help secure early diagnosis and treatment.
Abdominal migraine in children
Abdominal migraine is prevalent in children ages five to nine years old and rarely occurs in adults. The prevalence among children is 4 percent while the mean age of onset is 7 years old. “Abdominal migraine resolves in about 66 percent of patients by their late teens and 50 to 70 percent will go on to develop migraine attacks associated with head pain that is a well known and prominent feature of migraine,” said Dr. VanderPluym. Migraine is a polygenetic disease and, similarly, the incidence of abdominal migraine is linked to other family members with migraine.
Symptoms of abdominal migraine
Abdominal migraine consists of episodes of abdominal pain that may be accompanied by nausea, vomiting, loss of appetite or loss of facial color. The abdominal pain is generally located in the middle of the abdomen. Patients often describe it as dull or sore, but it can become moderate and even severe. Between episodes, there should be no symptoms. According to Dr. VanderPluym, “Attacks last between 2-72 hours.” Notably, abdominal migraine doesn’t impair a child’s growth or development.
Diagnosing abdominal migraine
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,” said Dr. VanderPluym. For example, if your child shows alarm signs like fever, weight loss, poor growth, chronic diarrhea or blood in the stool or vomit, investigation into other causes should be completed. Certain gastrointestinal, urogenital or metabolic conditions may mimic abdominal migraine, so it’s important to get a diagnosis to begin the most effective course of treatment.
Treating abdominal migraine
Many of the treatments used for more typical forms of migraine are often used to treat abdominal migraine because there are no FDA-approved treatments for either pediatric or adult abdominal migraine. Acute treatments include acetaminophen, anti-nausea medication and triptans, while hydration is particularly effective if the patient experienced significant vomiting. It’s important to visit a licensed pediatrician for a personalized treatment plan as children will require appropriate dosing of any medication according to body weight.
If your child experiences frequent abdominal migraine attacks, preventive therapies such as flunarizine, beta blockers, cyproheptadine, amitriptyline and topiramate should be explored. Biofeedback and cognitive behavioral therapy are two non-medication based options also worth considering as they are thought to show efficacy in treating migraine.
The American Migraine Foundation’s resource library is constantly updated with doctor-sourced information about new treatments and different types of migraine. For more information about pediatric migraine, read this article or download a copy of this free guide to caring for a child with migraine.