Understanding Abdominal Migraines

This migraine variant typically occurs in childhood

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If you have a child with recurrent abdominal pain, it's possible that it is due to a form of functional abdominal pain called abdominal migraine. This condition, which is a migraine variant, affects around 2 percent to 4 percent of all kids and about 4 percent to 15 percent of children with chronic periodic abdominal pain of an unknown cause. These migraine attacks usually begin between 3 and 10 years of age, with a peak incidence at 7 years.

While this headache disorder is classically diagnosed only in children, it's occasionally diagnosed in adults who see their doctors for incurable abdominal pain.

Symptoms

As the name of the condition indicates, pain is felt in the abdominal area. Usually, children will point to their belly buttons or around that area, but the pain can be anywhere in the midline location, according to criteria from the International Classification of Headache Disorders (ICHD). The pain has a dull quality, is typically moderate to severe in intensity, and interferes with a child's regular daily activities, so it's not something kids can typically put out of their minds.

There are two sets of specific diagnostic criteria that physicians can use—IHCD's and the Rome IV. According to these criteria, at least two of the following symptoms are present along with abdominal pain during an abdominal migraine:

  • Loss of appetite (ICHD, Rome IV)
  • Nausea (ICHD, Rome IV)
  • Vomiting (ICHD, Rome IV)
  • Paleness, which can cause dark under-eye circles (ICHD, Rome IV)
  • Sensitivity to light (Rome IV)
  • Headache (Rome IV)

According to the ICHD, headache isn't generally a significant symptom during an abdominal migraine attack and, unless a child is asked, it may be overlooked altogether. The ICHD recommends that if children have head pain along with the abdominal pain, physicians should at least consider a diagnosis of migraine without aura instead of abdominal migraine, which is why ICHD criteria don't include headache.

While Rome IV diagnostic criteria are similar to the ICHD's, Rome IV includes sensitivity to light and headache as other possible symptoms, stating that intense abdominal pain should be the worst symptom.

An abdominal migraine can last anywhere from two to 72 hours if it's not treated or treatment is unsuccessful. In between attacks, children have no symptoms.

Diagnosis

There's no slam-dunk test to confirm a diagnosis of abdominal migraine, just the two sets of specific diagnostic criteria. Abdominal migraine is a diagnosis that's made based on the symptoms mentioned above, so your child's doctor will perform a physical examination and inquire about your child's medical and family history.

In 34 percent to 90 percent of kids with abdominal migraine, there's a first-degree relative with a history of migraine, and 24 percent to 47 percent of these kids themselves have also experienced migraine.

A key part of diagnosing abdominal migraine is to rule out other sources of your child's stomach pain, like gastrointestinal or kidney disorders, an obstruction, an infection, or anatomical, inflammatory, or metabolic causes. The process of ruling out other problems may involve blood tests, imaging, urine and stool tests, and possibly even a colonoscopy, depending on what your doctor is looking for.

Learning that your child doesn't have any major abdominal pathology can be reassuring to you both and may actually help reduce symptoms.

Treatment

Unfortunately, there aren't a lot of studies that have adequately assessed the treatment of abdominal migraines, but there are a few ways to help your child reduce the pain of abdominal migraines, or even avoid them altogether.

Lifestyle

Your doctor will likely recommend some lifestyle habits that can help manage abdominal migraine symptoms, such as:

  • Healthy sleep habits
  • Adequate fluids
  • Avoiding stress when possible
  • Dietary changes, such as avoiding any food triggers and trying a high-fiber diet or a lactose-free diet

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT) may be helpful for kids with abdominal migraine, especially since it has been shown to be beneficial for kids with migraine headaches.

Few studies have been done on the efficacy of CBT for abdominal migraine, but considering how closely linked this condition is with regular migraine, it stands to reason that CBT might be a good treatment strategy.

Medications

Non-pharmacological options are the first-line for treating abdominal migraine, but if your child isn't responding to these methods or his or her abdominal migraines are frequent or severe, your doctor may recommend medication.

For an acute attack, over-the-counter pain relievers like Tylenol (acetaminophen) or Motrin/Advil (ibuprofen) can be useful if they're given early enough. That said, studies haven't been done on how effective these are at treating abdominal migraine, so your results may vary.

Nasal sumatriptan, a prescription medication, may also be effective in treating acute abdominal migraines.

If your child needs preventive medication, the types that have been found to be the most effective in preventing abdominal migraines for children include:

  • Inderal (propranolol), a beta-blocker
  • Periactin (cyproheptadine), an antihistamine
  • Flunarizine (a calcium channel blocker)
  • Pizotifen, an antihistamine
  • Depakote (valproate), an anticonvulsant

For adults, Topamax (topiramate) may be a good preventive option, according to a study in Annals of Pharmacotherapy. The study also noted that calcium channel blockers, beta-blockers, and antihistamines have been shown to be effective, though there are few studies overall on adults with abdominal migraine.

Prevention

Avoiding potential triggers may help prevent your child's abdominal migraines. Common triggers of this condition include:

  • Foods like citrus, chocolate, cheese, carbonated beverages, added colorings and/or flavorings, and foods that are high in amines (e.g., tyramine, histamine, phenylethylamine, polyamines, xanthines), which are found in caffeine
  • Not getting enough sleep or poor quality sleep
  • Traveling
  • Bright or flickering lights
  • Going without eating for too long
  • Stress

As with a regular migraine, it's a good idea to keep a migraine diary for at least a month, and preferably for two or three, especially if you're not sure what triggers your child's abdominal migraines. This allows you to keep track of factors like how often the migraines are happening; how painful they are; what your child ate (or didn't eat) before the migraine started; whether or not medication helped; how long the migraines lasted; what time of day they occurred; and potential precipitating factors, which can help you spot patterns that may pinpoint triggers.

At the very least, a migraine diary can be helpful to your child's doctor when deciding on a treatment plan and/or diagnosis. He or she may be able to help you find your child's triggers too.

Outlook

Most kids outgrow their abdominal migraines by the time they hit their early teens, though these can, on rare occasions, persist into adulthood.

However, according to the ICHD, the majority of children who've had abdominal migraines eventually start having migraine headaches, with or without aura, instead. In fact, abdominal migraine is considered to be a precursor of migraine headaches.

A Word From Verywell

Chronic abdominal pain in children can have a significant negative impact on their quality of life and interfere greatly with their peer relationships and school/social functions. If your child has chronic, recurrent abdominal pain, it might be a good idea to undergo a thorough workup by a gastrointestinal specialist. At the very least, talk to a primary care physician about your concerns and bring a migraine diary along if you can. The same applies if it's you who is experiencing these symptoms.

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