Abdominal Migraine

Abdominal migraine is a common type of migraine attack that occurs usually without the headache, but presents as central upper abdominal pain, with facial flushing and pale coloration, often with episodes of vomiting in a child or adult with family history of migraine.

This pain may be preceded by feeling of listlessness, drowsiness, lethargy and migraine-like aura such as flashing lights, visual chaos like seeing strange dots and lines, yawning and withdrawal from bright light.

Abdominal migraine is a not well understood and often ignored cause of abdominal pain in millions of people worldwide.

It is also called Tummy Migraine, Non – headache migraine, and may be associated with cyclic vomiting syndrome (CVS). Abdominal migraine is a totally different entity from recurrent abdominal pain syndrome

It affects both adults and children, though much more common in children before the age of 12, with peak incidence at three and half years of age.

It is also more common in girls.

It is thought that this illness strongly related to migraine originates from an area of the brain called area post-trema. It is due to a disordered intestinal motility triggered by abnormal brain waves.

Symptoms of Abdominal Migraine

Abdominal migraine typically causes recurrent attacks of central abdominal pain, usually around the umbilicus or belly button, lasting for several hours with associated nausea, vomiting and occasionally one sided headache.

The sufferer may become pale and the pulse may be difficult to feel, or even run very slowly. They may also become very flushed.

Like those with migraine, there may be a preceding aura of visual disturbance, flashing lights, numbness or tingling sensation around the mouth, arm or a side of the body, slurred speech, muscle weakness or even paralysis.

The child or adult may become emotionally withdrawn, with altered sleep pattern. There is associated dislike or sensitivity to light and sound too. The pain typically starts in the morning. It is so serious to interfere with day to day life.

In between episodes, they are usually totally free from abdominal pain and feel okay again. The pain typically last for about 2 - 72 hours. In reality, the abdominal pain last for at least four hours, and may keep re-occurring for the next three to four days with symptoms free interval.

Diagnosis of Abdominal Migraine

There is no definite test that can be performed to diagnose this condition.

The diagnosis is suspected from a careful history and some form of imaging (scan) may help to shed more light on the likelihood of symptoms being due to abdominal migraine.

The history is usually typical. Recurrent attacks of abdominal pain. Pain could be any where in the abdomen, but most often around the umbilicus, or upper abdomen lasting for hours with symptoms free period in between.

There is usually a family history of migraine, often in the mother.

An EEG (brain wave scan called electro-encephalography) will demonstrate patterns suggestive of epilepsy.

Visual Evoked Response (VER) test to red and white flash light may give further indication of the presence of abdominal migraine in a child. Those with abdominal migraine display a fast wave form response to flashing light than normal children.

It is important to conduct other basic tests to confirm that the cause of a child or indeed adult’s recurrent vomiting and abdominal pain is not some very serious and potentially fatal conditions like bowel obstruction or some infections.

The diagnosis of abdominal migraine is one of exclusion.

Triggers and Causes of Abdominal Migraine

The exact cause of abdominal migraine is not known, except that it is thought to originate in certain parts of the brain, including the amygdala, area post-trema and hippocampus.

A high incidence of abdominal migraine has been reported in individuals with neurofibromatosis, especially type one. It is a very common cause of abdominal pain in these patients.

Triggers of abdominal migraine are more or less the same for migraine. These include

  • Emotional or severe physical stress, anger, grief, depression
  • Extreme of temperatures
  • Bright flickering lights associated with watching television or computer screens for a long time,
  • Consumption of chocolate, mono sodium glutamate, fizzy drinks, caffeine, cheese, alcohol, red wine, citrus fruit, and a host of other food items. Infrequent meals, starvation,
  • Hormonal changes occurring during menses, or menopause or during HRT being started or stopped.

Individuals should study and note things or food items that triggers attack in them and avoid these.

Treatment of Abdominal Migraine

Once an attack has started, there is very little that can be achieved in terms of treatment.

Reassurance and rest may help more than medications. Lying in a dark quiet place has provided relief for some.

Like migraine, the best treatment is prevention.

Medications that have been used with success in the treatment of abdominal migraine include:

  • Paracetamol and or ibuprofen which may help take the edge off the abdominal pain.

  • Intra nasal sumatriptan - imigraine used in treating migraine has been found to help shorten attacks in some indivduals

If abdominal migraine is frequent and troublesome, sufferers could be placed on long term preventive medications for up to six months and then stopped. Most often, once there is no attack for a long tine, and triggers are avoided, one could lead an attack free life for a very long time.

The commonly used long-term preventive medications include:

Most children out grow this disorder and may even develop migraine as adult.

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