Like adults, children can develop migraines. This can be the same type of condition seen in adults, which is typically occurs with a headache, and is sometimes preceded by an aura. Nausea, vomiting, and photophobia (decreased tolerance to light) can occur.
Children also develop some unusual and atypical variations of migraine, not associated with headaches in particular, that are not usually observed in adults. Abdominal migraine is one of these variants.
Abdominal migraine is a condition thought to be related to migraine that is characterized by pain in the abdomen. It is often precipitated by the usual triggers of classic migraine. The pain can be severe, and nausea and vomiting can occur.
Abdominal migraine is rare in adults, but it has been estimated that up to 2% of all children may develop abdominal migraines.
Children who have the condition usually go on to develop migraine headaches as adults. Girls are affected more frequently than boys. Abdominal migraine typically occurs for the first time between the ages of 2 and 10.
What causes abdominal migraine?
The cause of abdominal migraine is poorly understood. Abdominal migraine is thought by some researchers to be related to neurologic or endocrinologic changes and may be caused by alterations in the levels of serotonin and histamine in the body.
Genetic factors may also be involved as the condition is more common in children who have a family history of migraine. About 60% of children with the condition have a positive family history for migraine.
Triggers for abdominal migraine have been described, similar to triggers for classic migraine. These include chocolate or nitrite-containing foods, stress, and anxiety.
What are the symptoms?
The episodes of pain are of moderate-to-severe intensity and are felt in the midline of the abdomen, usually around the belly button, or poorly localised (all over the abdomen).
The attacks of pain are usually accompanied by little desire to eat and nausea (feeling of sickness). Approximately half of those affected will vomit with at least some attacks.
Other symptoms can include photophobia (sensitivity to light), phonophobia (sensitivity to sound) and dizziness. Children may seem pale, although some children may appear flushed during an attack.
The symptoms of abdominal migraine normally appear in childhood before puberty, reaching a peak at the age of 12 years and thereafter falling rapidly.
In people affected the symptoms of abdominal migraine will resolve with age, but in one third of patients the symptoms will persist until the teenage years.
Most patients will develop migraine headaches (see entry Migraine). Very occasionally the onset of symptoms may be during the teenage years or in adults
The onset of attacks of abdominal pain may be at any time of day but occur most frequently first thing in the morning on waking.
The attacks are self-limiting (eventually will stop) and resolve without treatment and patients are completely well and symptom free between attacks.
How is it doagnosed?
Recurrent abdominal pain is a common problem in children, although most do not have abdominal migraine. The diagnosis should only be used where the specific features of the condition are present.
Doctors may arrive at a diagnosis of abdominal migraine once other conditions causing similar symptoms have been excluded.
Some research has suggested that there is a change in brain wave recordings when there is photic (flash light) stimulation of the eyes in those with abdominal migraine. However in the large part, this is not used as a method of diagnosis.
How is it treated?
Acute attacks of abdominal migraine are usually treated by rest and the condition frequently resolves with sleep. Patients should be allowed to lie down undisturbed in a quiet and dark room.
Simple analgesic (pain-relieving) drugs may be helpful in relieving attacks.
There is good evidence from a controlled clinical study that pizotifen may reduce the frequency and intensity of attacks when given regularly to prevent attacks.
In some cases, resolution of symptoms with treatment using pizotifen can confirm a suspected diagnosis of abdominal migraine. It has been suggested that propranolol may also be effective but no controlled clinical trials have been carried out.
Occasionally a one off trial of intra-nasal sumatriptan might be helpful to stop an attack, and, if successful in treating the symptoms, may establish the diagnosis as that of abdominal migraine.
Medications to treat abdominal migraine
Types of medications that may be used to manage abdominal migraine include:
- Analgesic drugs, such as nonsteroidal anti-inflammatory medications (NSAIDs) or acetaminophen
- Sumatriptan (Imitrex, Alsuma), a member of the triptan class of drugs used to treat migraine in adults, has been used to treat some older children with abdominal migraine
- Tricyclic antidepressants and drugs that block the effects of serotonin have been used in some patients to decrease frequency of attacks.
- Valproic acid (Depakote), an antiseizure medication, has been used to treat abdominal migraine.
- Ergotamine medications, also used for adults with migraine, are used to treat some childhood variants of migraine.
- Low dose aspirin and low dose beta-blocker medications have been used over the long term in some patients in an attempt to diminish the frequency of future attacks.
- The antihistamine cyproheptadine has been shown to be effective in some children with migraine variants.
- Other aspects of treatment may include the administration of intravenous fluids if vomiting is severe, and the use of sedatives or antiemetic drugs.
Treatment may also include advice to recognize and avoid triggers, if these are known. For example, if food triggers have been identified, these should be avoided, although not all those who experience abdominal migraine have identifiable food triggers.
Stress management and relaxation programs may be of benefit to some.
Inheritance patterns and Prenatal Diagnosis
A family history of migraine is frequently seen in abdominal migraine and as with other forms of migraine.
The condition appears more commonly to be inherited from the mother, although no firm genetic basis has been identified.
What is the prognosis for abdominal migraine?
The prognosis for abdominal migraine is good; most children eventually stop having the attacks of abdominal pain.
However, most children (about 70% in one study of 54 children) who have abdominal migraine go on to develop migraines in adulthood.