Abdominal Migraines in Children

Abdominal pain is one of the most common symptoms in a person of any age but is a more common complaint in the childhood. It is often non-specific meaning that it does not clearly indicate a possible cause and in the absence of other symptoms, abdominal pain can be difficult to diagnose without further investigations. Often abdominal pain is used as an excuse by children to feign illness and avoid a situation that may be undesirable. It is therefore not given the proper attention when there are no other symptoms to verify an existing problem. However, there is a condition known as abdominal migraines that seems to be under diagnosed in children. With abdominal migraines, there may be episodes of intense abdominal pain with or without other symptoms that are largely related to the digestive tract.

What are abdominal migraines?

Abdominal migraines are a condition marked by recurrent episodes of abdominal pains due to no known cause. Although the term migraines commonly refers to a type of headache, abdominal migraines are a chronic recurrent type of abdominal  pain. It can occur in both adults and children but is more common in childhood. Abdominal migraine is more frequently seen in children of parents who have migraine headaches. These children also tend to develop migraine headaches in adulthood.

Abdominal migraine meaning

Abdominal migraine does not only refer to the episodes of abdominal pain but is a syndrome meaning that there are several symptoms that occur together.  The reason why abdominal migraines occur and how it happens is not clear. It is believed to be associated with an abnormal interplay of certain hormones and chemicals that naturally occur in the body. Not every case of recurrent abdominal pains over a period of time is due to abdominal migraine. It is believed to affect about 9% to 15% of children and adolescents (1).

Although abdominal migraines are closely related to migraine headaches, it does not mean that every child with abdominal migraines will grow up to suffer with migraine headaches. However, the two conditions although being pain at different sites are closely related. Abdominal migraines are classified as a migraine variant and more specifically as a childhood periodic syndrome that precedes the adult onset of migraines in most but not all cases. Other similar childhood syndromes that are migraine variants include cyclic vomiting syndrome and benign paroxysmal vertigo.

Abdominal migraine causes

The cause of abdominal migraine is unknown. There appears to be some association with abnormalities in the levels of two naturally occurring chemicals known as serotonin and histamine. It is believed that the fluctuations of these chemicals may also be responsible for migraine headaches. There also appears to be a link with stress and anxiety which could possibly serve as a trigger for fluctuations of the serotonin and histamine levels. The exact process by which this occurs is not clearly understood. However, it is important to note that abdominal migraines is not a psychiatric condition although it may have a psychological trigger.

Stress

The role of psychological stress in abdominal migraines does create confusion in determining psychosomatic abdominal pain and actual abdominal migraines. It is not uncommon for children to complain of abdominal pain as a means of avoiding stressful or undesirable situations. Whether the abdominal pain in these instances actually exist or is imagined is debatable. It is  often said that where adults commonly experience headaches in relation to psychological stress, children experience abdominal pain. This does not mean that the headaches in adults or abdominal pain in children are migraine headaches or abdominal migraines respectively.

Food

Abdominal migraines also appears to be to be triggered with certain types of food particularly chocolate and foods containing MSG (monosodium glutamate). Other chemicals known as nitrites which are used to cure meats may also be a trigger. It appears that these factors are similar to known triggers of migraine headaches. However, it is not uncommon for there to be specific triggers that varies among individuals. It is therefore important to keep a diary of foods in a child with abdominal migraines in order to identify these unique triggers.

Abdominal migraine symptoms

The main symptoms of an abdominal migraine is a severe abdominal pain of a sudden onset. It occurs in episodes which may last for hours  to days and then resolve on its own only to recur again at a later stage. The abdominal pain is generalized meaning that it is over the entire abdomen and a child is unable to accurately localize the pain.  However, most children will agree that the most intense pain is centrally located on the abdomen, meaning it is towards the midline. The pain seems to subside with sleep. Usually there is no headache but in some cases a mild headache may accompany the abdominal pain.

The other prominent symptoms that are present in abdominal migraines is nausea and vomiting. These symptoms may be intense and exist for as long as the abdominal pains are present. Cyclic vomiting which is another type of childhood periodic syndrome may be seen as a variant of severe abdominal migraines. There is usually a lack of appetite during these periods due to the combination of abdominal pain, nausea and vomiting. The appetite often returns once the episode resolves. Another common symptom during these episodes is paleness (pallor).

The combination of other symptoms that accompany the pain in abdominal migraines serves as a more clear indication between abdominal pain due to abdominal migraines rather than abdominal pain which is imaginary or faked in an attempt to avoid undesirable situations. It is important to note that there are several other causes of abdominal pain in children that may be related to various diseases. Sometimes in these cases, abdominal pain is the first and only symptom for a period of time before other symptoms become apparent.

Abdominal migraine treatment

There is no definitive treatment for abdominal migraines since the exact cause and underlying mechanism has not been clearly identified. Certain medication that appears to be effective in treating and managing abdominal migraines have not been approved for use in children. The drugs that may offer some relief include tricyclic antidepressants, serotonin blockers and valproic acid. Conservative management particularly with regards to avoiding trigger foods and psychological stress is therefore recommended. Rest and reassurance are important measures in dealing with a child during an episode of abdominal migraine. Other medication such as NSAIDs may be considered for use although aspirin should be avoided in children.

References

1. Abdominal migraine. Medscape