Abdominal Migraine
Introduction
Diagnostic criteria for the periodic syndromes have evolved to encompass the term episodic syndromes that may be associated with migraine. Patients diagnosed with an episodic syndrome often evolve to develop migraine with and without aura1 (Table 1).
The episodic syndromes that may be associated with migraine include 3 main conditions: (1) recurrent gastrointestinal disturbance that includes the 2 components of cyclical vomiting syndrome and abdominal migraine, (2) benign positional vertigo, and (3) benign paroxysmal torticollis1 (Table 2). Abdominal pain occurs in 9%-15% of the pediatric population.2
This article focuses on the diagnosis and management of abdominal migraine. The presenting symptoms of abdominal migraine overlap significantly with very serious gastrointestinal, neurologic, and metabolic disorders, which must be excluded before rendering the formal diagnosis of this condition. The affected children often report significant disability that interferes with school, social, and family activities.2 The treatment of this disorder has not been well studied and thus the data available are primarily clinical. Current knowledge about early management as well as preventive therapies is outlined in this article.
Section snippets
Abdominal Migraine
Abdominal migraine presents mainly in children between the ages of 3-10 years with onset of recurrent episodes of moderate-to-severe midline abdominal pain lasting from 2-72 hours, accompanied by anorexia, pallor, nausea or vomiting or both.1 The abdominal pain is located periumbilically in most patients, but can be poorly localized (Table 3). The quality of the abdominal pain is frequently described as dull or just sore, not colicky, interfering with normal daily activities in 72% of patients.2
Conclusion
The diagnosis of abdominal migraine, especially when it presents in the absence of headache, can be quite challenging. Abdominal migraine is stereotyped by episodic attacks with patient’s returning to baseline and having symptom-free intervals. It is imperative that an accurate diagnosis be made as soon as possible. A careful history, physical examination, and appropriate diagnostic tests are necessary to confirm the diagnosis and to then outline a successful management strategy. There has been
References (11)
- et al.
Childhood periodic syndromes
Pediatr Neurol
(2010) - et al.
Abdominal migraine and treatment with intravenous valproic acid
Psychosomatics
(2006) - et al.
The international classification of headache disorders, 3rd edition (beta version)
Cephalalgia
(2013) - et al.
Prevalence and clinical features of abdominal migraine compared with those of migraine headache
Arch Dis Child
(1995) - et al.
Clinical epidemiology of childhood abdominal migraine in an urban general practice
Dev Med Child Neurol
(1998)
Cited by (10)
The kynurenine pathway of tryptophan metabolism in abdominal migraine in children – A therapeutic potential?
2024, European Journal of Paediatric NeurologyDiagnoses of Exclusion in the Workup of Abdominal Complaints
2021, Emergency Medicine Clinics of North AmericaCitation Excerpt :Prevalence tends to decrease with age although adult cases have been reported.27 The patients with AM present with recurrent episodes of intense, acute abdominal pain and a combination of nausea, vomiting, anorexia, and pallor.28 Diagnostic criteria have been set forth by the Rome group (Box 2).29
Evaluation of functional gastrointestinal disorders in children aged 4-10 years with autism spectrum disorder
2024, Turkish Journal of PediatricsCommon gastrointestinal conditions in pediatrics
2023, Pediatric Psychogastroenterology: A Handbook for Mental Health ProfessionalsMigraine Precursors in the Pediatric Population
2023, Pediatric Headache: Evaluation through Treatment for the General Provider