Abdominal migraine
SpecialtyNeurology
Symptomsepisodes of abdominal pain
Usual onsetvariable
Causesmigraine triggers
Risk factorscyclic vomiting syndrome, PTSD, functional gastrointestinal disorder
Diagnostic methodsymptoms
Differential diagnosisirritable bowel syndrome, peptic ulcer disease, gastroesophageal reflux disease, mast cell activation syndrome, celiac artery compression syndrome
Preventionavoiding triggers (different for each patient)
Treatmenta range of experimental medications, including TCAs and anticonvulsants
Prognosisgood in pediatrics, variable in adults
Frequencybetween 1% and 9% of children
Deathspoorly studied

Abdominal migraine (AM) is a functional disorder that usually manifests in childhood and adolescence, without a clear pathologic mechanism or biochemical irregularity. Children frequently experience sporadic episodes of excruciating central abdominal pain accompanied by migrainous symptoms like nausea, vomiting, severe headaches, and general pallor.[1] Abdominal migraine can be diagnosed based off clinical criteria and the exclusion of other disorders.[2]

The US Food and Drug Administration has not approved any drugs for the treatment of abdominal migraine. The goal of treatment is usually to prevent attacks, and this is often achieved through nonpharmacologic intervention.[3]

Research has indicated that the incidence of abdominal migraine in children falls within the range of 0.4%[4] to 4%.[2] The condition primarily affects children aged 3 to 10 years, with a higher prevalence in females.[5]

Signs and Symptoms

Midline abdominal pain with paroxysmal, recurrent, acute onset attacks that last an average of 17 hours are the hallmarks of abdominal migraine.[6] There have been reports that these attacks can last anywhere from two to seventy-two hours.[5] Although it has also been reported to be diffuse and colicky, the pain is usually described as dull and periumbilical. 91% of patients have anorexia, 73% to 91% have nausea, 35% to 50% vomit, and 93% to 100% of patients have associated pallor.[7] The attack usually comes to an abrupt end.[5] The average annual frequency of abdominal migraine attacks in patients is 14.[6]

Although nonspecific prodromes can occur before attacks, abdominal migraine attacks are usually sporadic. This can include behavioral and mood swings, anorexia, flushing, diarrhea, and auras that include numbness, slurred speech, tingling in the distal extremities, and flashing lights.[5] Weeks to months may pass between episodes, and during this time patients usually experience no symptoms.[8]

Causes

Abdominal migraine has been linked to specific alterations in the gut-brain axis, vascular dysregulation, modifications in the central nervous system, and genetic factors.[9]

Risk factors

Abdominal migraine pathophysiology may involve psychological factors. Abuse and stressful events are two risk factors for recurrent abdominal pain, for instance. Furthermore, it has been demonstrated that kids with functional gastrointestinal disorders experience mental health conditions like anxiety and depression more frequently than kids without these conditions.[10]

Triggers

There are several typical causes of attacks of abdominal migraines. Stressors related to work and family life, irregular sleep patterns, extended fasts and food deprivation, dehydration, exercise, travel, high-amine foods, foods containing flavoring, coloring, and monosodium glutamate (MSG), and flashing lights are a few common triggers.[5][8]

Genetics

A significant hereditary component may be involved in abdominal and other migraines due to their strong familial incidence,[11] especially in the case of mutations affecting cell membrane transport (channelopathies).[12][13]

Mechanism

While the pathophysiology of functional gastrointestinal disorders (FGIDs) has many potential contributors, the etiology of abdominal migraine is still unknown.[14]

It is thought that abnormal electrical discharge from the hypothalamus that travels to the cortex and autonomic nervous system[15] or variations in the cerebral artery's blood flow velocity cause attacks.[16] In patients with FGIDs, there appears to be a disruption in the complex brain-gut axis.[17] Many episodic functional gastrointestinal disorders in childhood have been linked to mitochondrial disease,[18] hypothalamic-pituitary-axis dysfunction, and gene mutations; these associations have not, however, been studied in patients diagnosed with abdominal migraine.[19]

Diagnosis

It's critical to rule out organic diseases as the source of a child's symptoms while also taking the patient's functional state into account. When diagnosing abdominal migraine, a patient's complete medical history and physical examination are crucial. Additionally, any potential alarm signs and symptoms should be carefully examined. The presence of visible or occult blood in the stool, dysphagia, hematemesis, bilious vomiting, fever, changes in growth pattern, weight loss, and bilious vomiting are a few examples of alarm symptoms.[20] Further imaging and testing should be carried out if these alarm signs and/or symptoms are apparent.[21]

The Rome IV criteria state that paroxysmal bouts of intense, acute periumbilical, midline, or diffuse abdominal pain lasting at least an hour, exhibiting a recurrent pattern, being incapacitating, and interfering with regular activities can be used to diagnose abdominal migraine if at least two of these episodes take place over a six-month period. There should be weeks or months without any symptoms in between attacks. The following symptoms must be present in at least two instances: pallor, photophobia, headache, nausea, vomiting, and anorexia. Lastly, there is no other medical diagnosis that can account for the symptoms.[22]

Abdominal migraine is defined by the International Classification of Headache Disorders III criteria as five or more episodes of abdominal pain lasting two to seventy-two hours. A minimum of two out of three of the following criteria must also be met by the pain: dull or "just sore" quality; midline location, periumbilical, or poorly localized; and moderate to severe intensity. Pallor, nausea, vomiting, and anorexia are associated symptoms that the patient should have at least two of.[7]

Differential diagnosis

Abdominal migraine must be distinguished from other causes of chronic or recurrent abdominal pain. These include irritable bowel syndrome, peptic ulcer disease, and gastroesophageal reflux disease.[3] It must also be distinguished from causes of acute abdominal pain, such as appendicitis, as wrong diagnosis may lead to unnecessary appendectomy.[23]

Treatment

Because there are so few studies in the literature, there are no firm recommendations for the treatment of abdominal migraines.[24] The majority of treatment options are predicated on anecdotal evidence, a small number of studies conducted on a relatively small number of children, and a close correlation between abdominal migraines and both migraine headaches and FGIDs.[25]

When treating patients with abdominal migraines, doctors may find the STRESS mnemonic useful. It stands for stress management, travel advice, rest, emergency symptoms, sparkling lights, and snacks to avoid.[26]

Certain triggers, like bright light, restless nights, travel, and extended fasting, should probably be minimized or avoided once they have been identified.[19] Emotional stressors from family or school activities can be a trigger for certain kids, so it's best to minimize or stay away from them.[3] Although there are no particular randomized trials evaluating the efficacy of biofeedback and counselling in treating abdominal migraines, it is believed that these interventions may be helpful if emotional stress is a trigger factor in the development of migraine in children.[27]

It's unclear what function elimination diets serve. Nonetheless, in patients experiencing both migraine and IBS symptoms, an immunoglobulin G (IgG)-based elimination diet shows promise in lowering migraine episodes.[28] There isn't much more proof that a child's diet has a significant impact on when migraines begin.[29]

In one study, 14 children with abdominal migraine were administered pizotifen syrup, a serotonin and histamine antagonist. After four months, 70% of the patients said their symptoms had improved. Their symptoms were noticeably milder and less frequent.[30] Propranolol and cyproheptadine syrup were found to alleviate symptoms in a retrospective review.[25] Flunarizine use was found to reduce the frequency and duration of abdominal migraine attacks in another retrospective review.[31]

Analgesics, triptans, and antiemetics may be helpful for sudden attacks of abdominal migraines. It has been suggested that patients with nausea, vomiting, or anorexia might benefit more from nasal sprays or suppositories.[5] Acute attacks have been reported to be resolved by acetaminophen and ibuprofen.[32] Intranasal sumatriptan alleviated the symptoms of abdominal migraine in two children, according to a case report.[33] In refractory cases, intravenous sodium valproate has been reported to resolve abdominal migraine episodes.[34] According to a case series, intravenous dihydroergotamine treatment prevented abdominal migraine attacks in five out of six pediatric patients.[35]

Prognosis

Abdominal migraine can have a significant impact on day-to-day life.[36] Children may miss school or other activities.[36] It resolves in many patients.[23][37]

Epidemiology

Abdominal migraine primarily affects children, for whom it is a common cause of chronic abdominal pain. It may be as high as 9% or as low as 1% among children.[23] It is rare in adults.[3] However, children diagnosed with abdominal migraines may have migraine headaches as adults.[38] The mean age of diagnosis is 7 years.[39][40] It appears to be slightly more common in women.[23]

History

This condition was first described in 1921 by Buchanan.[41] It was once considered a controversial diagnosis.[42] However, it is now accepted as a common cause of chronic abdominal pain in children.[43]

See also

References

  1. ↑ Angus-Leppan, Heather; Saatci, Defne; Sutcliffe, Alastair; Guiloff, Roberto J (February 19, 2018). "Abdominal migraine". BMJ. 360: k179. doi:10.1136/bmj.k179. ISSN 0959-8138. PMID 29459383.
  2. 1 2 Carson, Laura; Lewis, Donald; Tsou, Marc; McGuire, Erin; Surran, Brooke; Miller, Crystal; Vu, Thuy-Anh (2011). "Abdominal Migraine: An Under-Diagnosed Cause of Recurrent Abdominal Pain in Children". Headache: The Journal of Head and Face Pain. 51 (5): 707–712. doi:10.1111/j.1526-4610.2011.01855.x. ISSN 0017-8748. PMID 21395574. S2CID 6813605.
  3. 1 2 3 4 Russell, George; Abu-Arafeh, Ishaq; Symon, David N.K. (2002). "Abdominal Migraine". Pediatric Drugs. Springer Science and Business Media LLC. 4 (1): 1–8. doi:10.2165/00128072-200204010-00001. ISSN 1174-5878. PMID 11817981. S2CID 12289726.
  4. ↑ Uc, Aliye; Hyman, Paul E.; Walker, Lynn S. (2006). "Functional Gastrointestinal Disorders in African American Children in Primary Care". Journal of Pediatric Gastroenterology & Nutrition. Wiley. 42 (3): 270–274. doi:10.1097/01.mpg.0000189371.29911.68. ISSN 0277-2116. PMC 3232040. PMID 16540795.
  5. 1 2 3 4 5 6 Winner, Paul (2016). "Abdominal Migraine". Seminars in Pediatric Neurology. Elsevier BV. 23 (1): 11–13. doi:10.1016/j.spen.2015.09.001. ISSN 1071-9091. PMID 27017015.
  6. 1 2 Evans, Randolph W.; Whyte, Chad (May 30, 2013). "Cyclic Vomiting Syndrome and Abdominal Migraine in Adults and Children". Headache: The Journal of Head and Face Pain. Wiley. 53 (6): 984–993. doi:10.1111/head.12124. ISSN 0017-8748. PMID 23721241. S2CID 205159221.
  7. 1 2 Irwin, Samantha; Barmherzig, Rebecca; Gelfand, Amy (2017). "Recurrent Gastrointestinal Disturbance: Abdominal Migraine and Cyclic Vomiting Syndrome". Current Neurology and Neuroscience Reports. Springer Science and Business Media LLC. 17 (3): 21. doi:10.1007/s11910-017-0731-4. ISSN 1528-4042. PMID 28283964. S2CID 4458523.
  8. 1 2 Cervellin, Gianfranco; Lippi, Giuseppe (2015). "Abdominal migraine in the differential diagnosis of acute abdominal pain". The American Journal of Emergency Medicine. Elsevier BV. 33 (6): 864.e3–864.e5. doi:10.1016/j.ajem.2014.12.066. ISSN 0735-6757. PMID 25616589.
  9. ↑ Angus-Leppan, Heather (August 1, 2013). "Migraine: mimics, borderlands and chameleons". Practical Neurology. BMJ. 13 (5): 308–318. doi:10.1136/practneurol-2012-000502. ISSN 1474-7758. PMID 23906594. S2CID 33590756.
  10. ↑ Devanarayana, N. M.; Rajindrajith, S.; Perera, M. S.; Nishanthanie, S. W.; Karunanayake, A.; Benninga, M. A. (July 23, 2014). "Association Between Functional Gastrointestinal Diseases and Exposure to Abuse in Teenagers". Journal of Tropical Pediatrics. Oxford University Press (OUP). 60 (5): 386–392. doi:10.1093/tropej/fmu035. ISSN 0142-6338. PMID 25059210.
  11. ↑ Sutherland, Heidi G.; Griffiths, Lyn R. (2017). "Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders" (PDF). Headache: The Journal of Head and Face Pain. 57 (4): 537–569. doi:10.1111/head.13053. ISSN 0017-8748. PMID 28271496. S2CID 40801526.
  12. ↑ Giffin, N J; Benton, S; Goadsby, P J (2002). "Benign paroxysmal torticollis of infancy: four new cases and linkage to CACNA1A mutation". Developmental Medicine & Child Neurology. Wiley. 44 (7): 490–493. doi:10.1017/s0012162201002407. ISSN 0012-1622. PMID 12162387.
  13. ↑ DALE, RUSSELL C; GARDINER, ALICE; ANTONY, JAYNE; HOULDEN, HENRY (July 31, 2012). "Familial PRRT2 mutation with heterogeneous paroxysmal disorders including paroxysmal torticollis and hemiplegic migraine". Developmental Medicine & Child Neurology. Wiley. 54 (10): 958–960. doi:10.1111/j.1469-8749.2012.04394.x. ISSN 0012-1622. PMID 22845787.
  14. ↑ Azmy, Demiana J.; Qualia, Cary M. (November 30, 2018). "Review of Abdominal Migraine in Children". Gastroenterology & Hepatology. Millenium Medical Publishing. 16 (12): 632–639. PMC 8132691. PMID 34035698.
  15. ↑ Mortimer, M.J.; Good, P.A. (1990). "The VER as a Diagnostic Marker for Childhood Abdominal Migraine". Headache: The Journal of Head and Face Pain. Wiley. 30 (10): 642–645. doi:10.1111/j.1526-4610.1990.hed3010642.x. ISSN 0017-8748. S2CID 27579213.
  16. ↑ Good, Peter A. (1995). "Neurologic Investigations of Childhood Abdominal Migraine: A Combined Electrophysiologic Approach to Diagnosis". Journal of Pediatric Gastroenterology and Nutrition. Wiley. 21: S44–S48. doi:10.1097/00005176-199501001-00013. ISSN 0277-2116. PMID 8708868.
  17. ↑ Weydert, Joy A.; Ball, Thomas M.; Davis, Melinda F. (January 1, 2003). "Systematic Review of Treatments for Recurrent Abdominal Pain". Pediatrics. American Academy of Pediatrics (AAP). 111 (1): e1–e11. doi:10.1542/peds.111.1.e1. ISSN 0031-4005. PMID 12509588.
  18. ↑ Boles, R. G.; Zaki, E. A.; Lavenbarg, T.; Hejazi, R.; Foran, P.; Freeborn, J.; Trilokekar, S.; Mccallum, R. (August 5, 2009). "Are pediatric and adult-onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult-onset CVS with the migraine and pediatric CVS-associated common mtDNA polymorphisms 16519T and 3010A". Neurogastroenterology & Motility. Wiley. 21 (9): 936–e72. doi:10.1111/j.1365-2982.2009.01305.x. ISSN 1350-1925. PMID 19368653. S2CID 43046971.
  19. 1 2 Napthali, Kate; Koloski, Natasha; Talley, Nicholas J (2016). "Abdominal migraine". Cephalalgia. 36 (10): 980–986. doi:10.1177/0333102415617748. ISSN 0333-1024. PMID 26582952. S2CID 23764515.
  20. ↑ Di Lorenzo, Carlo; Colletti, Richard B; Lehmann, Horald P; Boyle, John T; Gerson, William T; Hyams, Jeffrey S; Squires, Robert H; Walker, Lynn S; Kanda, Pamela T (2005). "Chronic Abdominal Pain In Children: A Technical Report of the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition". Journal of Pediatric Gastroenterology & Nutrition. Wiley. 40 (3): 249–261. doi:10.1097/01.mpg.0000154661.39488.ac. ISSN 0277-2116. PMID 15735476.
  21. ↑ McFerron, Brian A.; Waseem, Shamaila (November 1, 2012). "Chronic Recurrent Abdominal Pain". Pediatrics in Review. American Academy of Pediatrics (AAP). 33 (11): 509–517. doi:10.1542/pir.33.11.509. ISSN 0191-9601. PMID 23118316.
  22. ↑ "Rome IV Criteria". Rome Foundation. March 6, 2023. Retrieved December 31, 2023.
  23. 1 2 3 4 Angus-Leppan, Heather; Saatci, Defne; Sutcliffe, Alastair; Guiloff, Roberto J. (19 February 2018). "Abdominal migraine". British Medical Journal. 360: k179. doi:10.1136/bmj.k179. ISSN 0959-8138. PMID 29459383. S2CID 5256538.
  24. ↑ Lundberg, P. O. (1975). "Abdominal Migraine-Diagnosis and Therapy". Headache: The Journal of Head and Face Pain. Wiley. 15 (2): 122–125. doi:10.1111/j.1526-4610.1975.hed1502122.x. ISSN 0017-8748. PMID 1150428. S2CID 23179583.
  25. 1 2 Worawattanakul, Mingmuang; Rhoads, J. Marc; Lichtman, Steven N.; Ulshen, Martin H. (1999). "Abdominal Migraine: Prophylactic Treatment and Follow-up". Journal of Pediatric Gastroenterology & Nutrition. Wiley. 28 (1): 37–40. doi:10.1097/00005176-199901000-00010. ISSN 0277-2116. PMID 9890466.
  26. ↑ Catala-Beauchamp, Aixa I.; Gleason, Robyn P. (2012). "Abdominal Migraine in Children: Is It All in Their Heads?". The Journal for Nurse Practitioners. Elsevier BV. 8 (1): 19–26. doi:10.1016/j.nurpra.2011.06.007. ISSN 1555-4155.
  27. ↑ Blume, Heidi K.; Brockman, Libby N.; Breuner, Cora C. (July 13, 2012). "Biofeedback Therapy for Pediatric Headache: Factors Associated With Response". Headache: The Journal of Head and Face Pain. Wiley. 52 (9): 1377–1386. doi:10.1111/j.1526-4610.2012.02215.x. ISSN 0017-8748. PMID 22804229. S2CID 23605499.
  28. ↑ Aydinlar, Elif Ilgaz; Dikmen, Pinar Yalinay; Tiftikci, Arzu; Saruc, Murat; Aksu, Muge; Gunsoy, Hulya G.; Tozun, Nurdan (December 6, 2012). "<scp>IgG</scp>-Based Elimination Diet in Migraine Plus Irritable Bowel Syndrome". Headache: The Journal of Head and Face Pain. Wiley. 53 (3): 514–525. doi:10.1111/j.1526-4610.2012.02296.x. ISSN 0017-8748. PMID 23216231. S2CID 34736265.
  29. ↑ Gelfand, Amy A. (2013). "Migraine and childhood periodic syndromes in children and adolescents". Current Opinion in Neurology. Ovid Technologies (Wolters Kluwer Health). 26 (3): 262–268. doi:10.1097/wco.0b013e32836085c7. ISSN 1350-7540. PMID 23549418.
  30. ↑ Symon, D N; Russell, G (January 1, 1995). "Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine". Archives of Disease in Childhood. BMJ. 72 (1): 48–50. doi:10.1136/adc.72.1.48. ISSN 0003-9888. PMC 1510964. PMID 7717738.
  31. ↑ Kothare, Sanjeev V. (2005). "Efficacy of flunarizine in the prophylaxis of cyclical vomiting syndrome and abdominal migraine". European Journal of Paediatric Neurology. Elsevier BV. 9 (1): 23–26. doi:10.1016/j.ejpn.2004.11.002. ISSN 1090-3798. PMID 15701563.
  32. ↑ Lewis, Donald W; Yonker, Marcy; Winner, Paul; Sowell, Michael (2005). "The Treatment of Pediatric Migraine". Pediatric Annals. SLACK, Inc. 34 (6): 448–460. doi:10.3928/0090-4481-20050601-10. ISSN 0090-4481. PMID 16018227.
  33. ↑ Kakisaka, Yosuke; Wakusawa, Keisuke; Haginoya, Kazuhiro; Saito, Akiko; Uematsu, Mitsugu; Yokoyama, Hiroyuki; Sato, Tetsuo; Tsuchiya, Shigeru (June 9, 2009). "Efficacy of Sumatriptan in Two Pediatric Cases With Abdominal Pain-Related Functional Gastrointestinal Disorders: Does the Mechanism Overlap That of Migraine?". Journal of Child Neurology. SAGE Publications. 25 (2): 234–237. doi:10.1177/0883073809336875. ISSN 0883-0738. PMID 19509407. S2CID 41114159.
  34. ↑ Tan, Violeta; Revelo Sahami, Alcira; Peebles, Rebecka; Shaw, Richard J. (2006). "Abdominal Migraine and Treatment With Intravenous Valproic Acid". Psychosomatics. Elsevier BV. 47 (4): 353–355. doi:10.1176/appi.psy.47.4.353. ISSN 0033-3182. PMID 16844896.
  35. ↑ Raina, Madiha; Chelimsky, Gisela; Chelimsky, Thomas (July 1, 2013). "Intravenous Dihydroergotamine Therapy for Pediatric Abdominal Migraines". Clinical Pediatrics. SAGE Publications. 52 (10): 918–921. doi:10.1177/0009922813492879. ISSN 0009-9228. PMID 23820001. S2CID 206405642.
  36. 1 2 Catto-Smith, AG; Ranuh, R (Nov 2003). "Abdominal migraine and cyclical vomiting". Seminars in Pediatric Surgery. 12 (4): 254–8. doi:10.1053/j.sempedsurg.2003.08.006. PMID 14655164.
  37. ↑ Napthali, Kate; Koloski, Natasha; Talley, Nicholas J (2016-07-19). "Abdominal migraine". Cephalalgia. 36 (10): 980–986. doi:10.1177/0333102415617748. ISSN 0333-1024. PMID 26582952. S2CID 23764515.
  38. ↑ "Headache: Hope through research". NINDS. April 2016.
  39. ↑ Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53:984–993
  40. ↑ Monteferrante, Nikolas, Ho, Jacquelyn, Wilhelmi, Brian, MD, JD, Uribe, Juan. Prevention of Perioperative Abdominal Migraine in a Patient Undergoing Spinal Fusion: A Case Report. A A Pract. 2021;15(6):e01484. doi:10.1213/XAA.0000000000001484.
  41. ↑ Tepper, Stewart J.; Tepper, Deborah E., eds. (2011-08-22). The Cleveland Clinic manual of headache therapy. New York: Springer. p. 96. ISBN 9781461401780.
  42. ↑ Davidoff, Robert A. (2002). Migraine : manifestations, pathogenesis, and management (2nd ed.). Oxford [u.a.]: Oxford Univ. Press. p. 81. ISBN 9780195137057.
  43. ↑ Mani, Jyoti; Madani, Shailender (2018-04-24). "Pediatric abdominal migraine: current perspectives on a lesser known entity". Pediatric Health, Medicine and Therapeutics. 9: 47–58. doi:10.2147/PHMT.S127210. ISSN 1179-9927. PMC 5923275. PMID 29733088.

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