Abdominal Migraine

Abdominal Migraine: Excerpt from The 5-Minute Pediatric Consult

Joel Friedlander, D.O., MBe

Abdominal Migraine - BASICS

Abdominal Migraine - description

Recurrent attacks of periumbilical pain with nausea, vomiting, headache, pallor, perspiration, slowing of pulse rate, fever, occasional diarrhea, and limb pain

Abdominal Migraine - epidemiology

Abdominal Migraine - incidence

• Occurs mostly in children, with a mean onset at age 7 years (3–10 years)
• Peak symptoms 10–12 years of age
• More common in girls (3:2)

Abdominal Migraine - prevalence

• May affect as many as 1–4% of children at some point in their lives
• Declining frequency toward adulthood

Abdominal Migraine - risk factors

Abdominal Migraine - genetics

Parents of affected children often have history of migraine headaches and motion sickness.

Abdominal Migraine - etiology

• May involve neuronal activity originating in the hypothalamus with involvement of the cortex and autonomic nervous system
• Serotonin is implicated, and blockade of serotonin receptors may prevent abdominal migraine.
• May involve some as yet ill-defined local intestinal vasomotor factors

Abdominal Migraine - DIAGNOSIS

Abdominal Migraine - signs & symptoms

2 episodes within 12 months meeting all of the following criteria:

• Paroxysmal intense periumbilical pain that lasts >1 hour
• Intervening episodes of health between episodes
• Pain that interferes with activity
• Pain associated with anorexia, nausea, vomiting, headache, photophobia, or pallor
• No evidence of inflammatory, anatomic, metabolic, or neoplastic process

Abdominal Migraine - history

• Pain usually lasts <6 hours.
• Pain can be located anywhere in abdomen, but more often in upper quadrants.
• No abdominal pain between attacks
• Repetition of identical abdominal crises, anywhere from 1/wk to several times a year
• Migraine in the history of patient or relatives
• Occasionally, presence of other migraine syndromes such as nausea, vomiting, perspiration, body temperature changes, focal paresthesias, radiation of pain to a limb, or general malaise
• Impaired consciousness (some degree of lethargy may occur)
• Ask about a family history of migraine headache or unexplained bouts of abdominal pain as children.

Abdominal Migraine - physical exam

Physical exam is unremarkable with a normal exam of the abdomen.

Abdominal Migraine - tests

Even if a patient meets most criteria for abdominal migraine, studies as outlined should be done to ensure that a more serious disorder does not exist. Abdominal migraine is a diagnosis of exclusion.

Abdominal Migraine - lab

• CBC with differential
• ESR
• CRP
• Urinalysis
• Amylase
• Lipase
• Stool heme-occult
• Stool culture
• Lactose breath test for lactose intolerance
• Lead level
• Evaluation for porphyria or familial Mediterranean fever
• Urine organic acids/plasma amino acids
• Ammonia level

Abdominal Migraine - imaging

• Obstruction series to assess for intermittent or partial bowel obstruction
• Upper GI to rule out anatomic abnormalities
• Ultrasound or CT scan to rule out mass lesion or chronic appendicitis
• Renal ultrasound to rule out UPJ obstruction
• Barium enema (during painful crisis) to rule out intussusception

Abdominal Migraine - diag proced-surgery

• EEG may help differentiate between abdominal migraine and abdominal epilepsy.
• Visual evoked response (VER) to red and white flashlight: Children with abdominal migraine may display a specific fast-wave activity response.

Abdominal Migraine - differencial diagnosis

• Infection:
  • Giardia
• Environmental:
  • Lead intoxication
• Tumors
• Metabolic:
  • Porphyria, lactose intolerance, female carriers of (X-linked) ornithine transcarbamylase (OTC) gene mutation
• Psychosocial:
  • Functional abdominal pain/irritable bowel syndrome
• Surgical:
  • Appendicitis, intussusception, biliary colic
• Inflammation:
  • Inflammatory bowel disease, peptic ulcer disease, mesenteric adenitis
• GI:
  • Irritable bowel syndrome, gastroesophageal reflux, wandering spleen, cyclical vomiting, recurrent abdominal pain, constipation
• Anatomic:
  • Meckel diverticulum, ureteropelvic junction obstruction
• Miscellaneous:
  • Abdominal epilepsy—but has a shorter duration of pain (minutes), altered consciousness during event, abrupt onset, abnormal discharges in EEG in 80%

Because it is usually a diagnosis of exclusion, many patients go through a large workup to rule out other causes of pain, sometimes including laparotomy.

Abdominal Migraine - TREATMENT

Abdominal Migraine - medication

• Medications are prophylactic and must be given on a daily basis.
• For most patients, risks of side effects and complications from the use of medications may outweigh the relief of pain, especially in children who are experiencing infrequent episodes.
• Suggested prophylactic and treatment agents include ergotamine, propranolol, cyproheptadine, sumatriptan, and SSRIs.
• If EEG or other data point to possible epilepsy, empiric treatment with anticonvulsants may be considered and weighed against possible side effects.
• If there are triggers, they should be avoided. Common triggers include caffeine, nitrites, amines, emotional arousal, travel, prolonged fasting, altered sleep, and/or flickering lights.

Abdominal Migraine - FOLLOW UP

• Most children outgrow abdominal migraines by early adolescence.
• A substantial percentage of patients may later develop more typical migraine headaches.
• Although nonspecific, EEG changes are seen more commonly among these children, very few go on to develop signs of epilepsy.
• 10% of children who have migraine headaches have suffered from unexplained abdominal pain prior to the onset of headache.
• Adult migraine headache sufferers experience abdominal pain more frequently than do tension headache sufferers.

Abdominal Migraine - bibliography

1. Barlow CF. The periodic syndrome–cyclic vomiting and abdominal migraine. Clin Dev Med. 1984;91:83–84.
2. Catto-Smith AG, Ranuh R. Abdominal migraine and cyclical vomiting. Semin Pediatr Surg. 2003;12(4):254–258.
3. Li BU, Balint JP. Cyclic vomiting syndrome: Evolution in our understanding of a brain-gut disorder. Adv Pediatr. 2000;47:117–160.
4. Mortimer MJ, Kay J, Janon A. Clinical epidemiology of childhood migraine in an urban general pediatric practice. Dev Med Child Neurol. 1993;35:243–248.
5. Rasquin A, Di Lorenzo C, Forbes D, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2006;130: 1527–1537.
6. Russell G, Abu-Arafeh I, Symon DN. Abdominal migraine: evidence for existence and treatment options. Paediatr Drugs. 2002;4:1–8.
7. Symon DY. Abdominal migraine: a childhood syndrome defined. Cephalalgia. 1986;6:223–228.
8. Weydert JA, Ball TM, Davis MF. Systematic review of treatments for recurrent abdominal pain. Pediatrics. 2003;111:e1–e11.

Abdominal Migraine - CODES

Abdominal Migraine - icd9

346.2 Variants of migraine

Abdominal Migraine - PATIENT TEACHING-MED

• To help child during bouts of pain, allow the child to do whatever makes him or her comfortable—rest, positioning, quiet.
• Whether the patient should be excused from school depends on various factors:
  • Frequency, severity, and duration of pain
  • Age, maturity, and coping skills of the child

Abdominal Migraine - FAQ

• Q: Does this mean my child will develop migraine headaches?
• A: There is an association between abdominal migraines in childhood and migraine headaches in later life. There is no good way to predict for sure whether your child will have migraine headaches.
• Q: I have 2 other younger children. What chance do they have of developing abdominal migraines?
• A: Although migraine headaches do tend to run in families, there is no known Mendelian inheritance pattern.
• Q: What can I do to help my child during bouts of pain?
• A: First, allow the child to do whatever makes him or her comfortable. This may mean rest, positioning, or being quiet. Acetaminophen and other pain relievers may help to a certain degree. Whether the patient should be excused from school depends on various factors such as the frequency, severity, and duration of the pain, as well as the age, maturity, and coping skills of the child.

Book Source Details

• Book Title: The 5-Minute Pediatric Consult
• Author(s): M. William Schwartz MD; et al.
• Year of Publication: 2008
• Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.

More About Headache-free migraine

• Back to disease: Headache-free migraine: Introduction
• Next Book Extract About Headache-free migraine: Headache and Migraine (The 5-Minute Pediatric Consult)
• More Book Extracts: All Online Books for Headache-free migraine

More Medical Textbooks Online about Headache-free migraine

Review other book chapters online related to Headache-free migraine:

Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 5-Minute Pediatric Consult Authors: M. William Schwartz MD; et al. Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7577-9

 » Next page: Headache and Migraine (The 5-Minute Pediatric Consult)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Headache and Migraine (The 5-Minute Pediatric Consult)
• Surveys relating to Headache-free migraine
• Ask Question about Headache-free migraine

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City