Abdominal Migraine in Children

• Abdominal migraine is believed to be a variant of migraine that is common in children but rare in adults.
• Abdominal migraine is characterized by pain in the center of the abdomen that may be severe.
• Symptoms can last for one hour or up to a several days.
• Nausea and vomiting may be associated with the pain.
• Sleep typically brings relief from abdominal migraine. Medications used to treat classic migraine can also be effective, although there is no single treatment that is known to be effective in all patients.
• Most children with abdominal migraine have a family history of migraine, and most go on to develop migraine as adults.
• The exact cause of abdominal migraine is poorly understood. It may be related to both neurologic and endocrinologic (hormone) factors.
• The diagnosis of abdominal migraine can be difficult, and depends upon ruling out other potential causes for the abdominal pain and symptoms. There is no one diagnostic test that confirms the diagnosis.

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.

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.

As mentioned, abdominal migraine causes pain in the abdomen that can be severe and debilitating. It is typically located in the middle portion of the belly, often around the umbilicus. Cramping, nausea, and vomiting can accompany the pain. Pallor (paleness) of the skin is often observed. There may not be associated headache. The symptoms are usually relieved by sleep and can last anywhere from one hour to several days.

Because of the frequent absence of headache, the condition can be difficult to diagnose, especially during the first episode. There is no specific test that can establish the diagnosis of abdominal migraine, so the diagnosis is based on exclusion of other conditions. Laboratory tests and imaging studies are usually directed to rule out other conditions that could be responsible for the symptoms. Electroencephalography (EEG) is sometimes done to rule out a seizure disorder as the cause of the symptoms.

The treatment of abdominal migraine has two components - to reduce symptoms of an acute attack and to prevent or lessen the severity of future episodes. Research to date has not provided sufficient data to firmly establish the role of any particular medication in either treating symptoms or preventing future episodes of abdominal migraine. Still, many patients respond to anti-migraine medications and other medications.

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.

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.