Abdominal migraine is a migraine attack that involves abdomen instead of head. Abdominal migraine is mainly observed in children and is less common in adults. Children between the ages of 7 to 10 are usually affected. Abdominal migraine is characterized by episodic abdominal pain at frequent interval with a relapse lasting several weeks or months. Pain is usually experienced around the umbilicus with other concomitant symptoms such as nausea, loss of appetite, skin pallor, vomiting etc. The pain typically lasts for one hour to 3 days. In between two attacks the child is absolutely symptom free.Around a century ago, Brams was the first person to use the term abdominal migraine for periodic attacks of abdominal pain. The exact cause of abdominal migraine is yet to be determined, but family history of migraine attack is known in almost 90 percent of patients. A child suffering from abdominal migraine most often suffers from migraine headache when he becomes adult. There is no specific treatment for abdominal migraine. This condition is treated symptomatically.
Symptoms of Abdominal Migraine
One the most important clinical finding in this condition is pain around the umbilicus or in midline area of abdomen.Pain can be mild or moderate disturbing the daily activity of the patient. Abdominal migraine usually occurs in children between the ages 3 to 10 years with peak prevalence between 5 to 7 years of age. Along with pain, the associated symptoms include nausea, vomiting, loss of appetite, skin pallor, dark circles around eyes. Pain typically lasts between 1 hour and 3 days. There may be several episodes of such pain in a year. However, between the attacks, the child is completely symptom free and healthy. There is no concomitant headache with abdominal migraine. Although the symptoms often confuse with many other gastrointestinal condition of childhood, its persistence for 1 to 72 hours and history of recurrent episodes distinguishes it from other conditions. Besides, there are no other pathological findings as against other digestive diseases.
Doctors do not know the exact pathophysiology of abdominal migraine. According to one theory, the problem may lie between the abdomen and brain connection. One study also points out its association with slow movement of the intestinal content. Abdominal migraine is common among patients who have any of the family members suffering from migraine, especially the mother. Both girls and boys are affected with this condition, but female preponderance is more as compared to boys. Certain factors are known to increase the risk of abdominal migraine such as stress and anxiety. Psychological problems can cause fluctuation in certain brain chemicals which may also trigger a chain of reaction producing symptoms of abdominal migraine according to one theory. It is also believed that nitrites present in certain foods such as chocolates, processed meat, Chinese foods items, may initiate symptoms of abdominal migraine. A history of motion sickness is also found either in the patient or in family member.
There is no specific test that may help to diagnose abdominal migraine. However, certain criteria will be used to diagnose this disease. Clinical examination, personal and family medical history is useful. For diagnosis of abdominal migraine criteria followed are:
- Five attacks of abdominal migraine lasting between 1 hour and 3 days.
- Normal health between two attacks that may last for weeks or months.
- Dull achy pain around the belly button.
- Presence of at least any two of these symptoms accompanied with pain; anorexia, nausea, vomiting, skin pallor.
- Abdominal pain interfering with daily activities.
- No evidence of involvement of any inflammatory, metabolic, or anatomic pathology. With the help of ultrasound and other tests suspected gastrointestinal diseases such as Crohn’s disease, irritable bowel syndrome, and kidney disease are excluded.
Abdominal migraine similar to migraine headache remains a clinical diagnosis. Certain medicines used to treat migraine headache are also used to treat abdominal headache once the condition is known. This may include anti inflammatory drugs, medicines to control nausea and vomiting, and triptan group of drugs. These medicines may be suitable in adults, but in children these medicines may be harsh. There are several alternative medical therapies that may be used for children. These are:
- Avoid triggers such as stress, traveling, too much of physical exertion, eating foods that contain nitrites,
- The child must sleep and rest in dark room.
- Give extra fluid to child if he is vomiting.
- Avoid chocolates and processed foods.
- To alleviate abdominal pain, place hot water bag on the abdomen.
- A cup of peppermint tea is also beneficial to reduce pain.
- Practice yoga and meditation to reduce stress and anxiety.