Abdominal Migraine

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Abdominal migraine is one of the episodic syndromes that may be associated with migraine, which often has its initial presentation in childhood. Recognition of these 2 conditions in the pediatric population is paramount to establish an appropriate diagnosis, treatment, and prevention. The aim of this article is to review the most recent International Classification of Headache Disorders-3 beta for abdominal migraine, and discuss the differential diagnosis and current suggested management.

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

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