Abdominal migraine
There's a lot of misinformation out there when it comes to abdominal migraine. This type of migraine is rare in adults but occurs often in children, and is well recognized by the medical community. The disease has been called by other names including periodic syndrome.
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Abdominal migraine, to put it as simply as possible, is involves pain in the abdomen, even when there's no headache. Typically, the pain lasts about two hours, but anywhere from 1-72 hours. Between attacks, things are fine. Sometimes there are other symptoms, such as nausea and/or vomiting, sensitivity to light, irritability, diarrhea, loss of appetite, headache (though not always) or the patient may become flushed or pale. Sometimes there are dark shadows under the eyes.
This type of migraine is very rare in adults. Most patients are children, especially those between the ages of 5 and 9. The child may be much younger than that - it's hard to know because children may not be able to express how they feel.
Abdominal migraine is surprisingly common in children. Some studies have suggested that around 2-4% of children may have this type of migraine. (via Headache and Migraine in Childhood and Adolescence by Vincenzo Guidetti, George Russell, Matti Sillanpaa, Paul Winner)
How do you know when you've got it?
Trying to diagnose abdominal migraine can be a very frustrating process! Often patients are
tested for everything under the sun before they're finally referred to someone who can make the correct diagnosis. It's especially difficult when young children have trouble explaining how they feel. An article on abdominal migraines at the National Headache Foundation website point out: Tests fail to reveal a cause for the pain. Occasionally there may be EEG findings suggestive of epilepsy but this is rarely related to seizures. Of course, if there's any hint of seizures the diagnosis will probably be different. Still, altered consciousness may be a feature of migraine. The symptoms may also be mistaken at first for appendicitis.
There are some ways that you can make an educated guess about the disease before doing a full battery of tests. Because migraine is believed to be genetically based, you'll find that most often there is a family member who also has migraine. Though the symptoms may be mistaken for the flu, you'll find that they come back, for example a couple of times in the same month, with no pain in between. The child may complain of motion sickness. The child will probably be healthy otherwise.
The pain is usually severe enough to interfere with normal daily activities. Most often the child will want to lie in a dark room and sleep.
Similarities between abdominal migraine and cyclical vomiting syndrome (CVS) have led some researchers to believe they are actually both a type of migraine.
Be sure to know your family medical history. Look for symptoms that may indicate migraine, since sometimes it's misdiagnosed or people just assume it's something different. Here are some more general tips for understanding migraine in children.
Besides medical history and family history, diagnosis usually involves a physical exam, tests (such as blood and urine tests), and imaging tests (such as sonography). It's important to rule out possible other causes of abdominal pain.
How is abdominal migraine treated?
Treatment is often similar to treatment used in other types of migraine. There are non-drug migraine treatments that have been helpful in both children and adults, such as biofeedback. Inderal (propranolol) has been used to treat migraine in children, and may be prescribed. Propranolol is in a drug class known as beta-blockers. It's a preventative medication. Cyproheptadine (Periactin) is also prescribed. It's an antihistamine which affects serotonin activity. Sometimes it's used in combination with Midrin, which contains isometheptene mucate, which also seems to have some effect on serotonin levels. It also contains a mild sedative and acetaminophen.
Perhaps the most popular class of drugs used for migraine are triptans. Though not all of these have been thoroughly tested for children, they may be of help (remember, never give a drug that's been prescribed for you to someone else, especially not to your child!). Recent tests show Imitrex (sumatriptan succinate) to be useful for children. The American Academy of Neurology and the Child Neurology Society recommends the nasal spray. Discuss your options with the doctor - it may take a few tries to find something that works well.
Childhood to adulthood
In many cases, a child with abdominal migraine will still have migraine as an adult, though the symptoms will most likely change to something more typical. This is another reason why it's important to gain an understanding of the disease early on. There is growing evidence that migraine can do permanent damage - the sooner it can be diagnosed and treated, the better. Also, with any new symptoms it's important to see your doctor. There could be other serious conditions that may do more damage sooner. It's better to be tested and rule out the other diseases that can cause stomach pain. There are dozens of reasons why you (or your child) may be experiencing abdominal pain.
References: The National Headache Foundation article on abdominal migraine, and the Adult's Guide to Children's Headaches; Migraines for Dummies by Diane Stafford and Jennifer Shoquist, MD; Headache and Your Child by Dr. Seymour Diamond and Amy Diamond; Dancing With Migraine Disease As A Youth from MAGNUM; Abdominal migraine simulating acute abdomen, Sangermani R, Pirovano S, Vaccari R, Gibelli M, Rossi A. 1992; Chronic Abdominal Pain in Childhood: Diagnosis and Management by Alan M. Lake, M.D. 1999, Headache and Migraine in Childhood and Adolescence by Vincenzo Guidetti, George Russell, Matti Sillanpaa, Paul Winner (2001)