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Abdominal Migraine

28 August, 2020


Abdominal Migraine

Approximate reading time: 2 - 3 minutes

Symptoms of Abdominal Migraines

Children are most likely to suffer from abdominal migraines. Sometimes children may to be too young to describe their symptoms but act a bit off, grasp at their stomach or go off their food.

Symptoms may include:

  • Intense belly pain
  • Nausea
  • Vomiting
  • Reduced food intake
  • Unhealthy pale appearance
  • Headache
  • Light or noise sensitivity

The stomach pain is the key symptom. Unlike other forms of migraines, headaches are not a standout feature. In fact some, children don't have a headache at all!

Instead the biggest concern is the belly pain. It tends to be in the middle of the stomach - like around the belly button - or vague - where your child cannot point where it hurts.

Running around and doing normal kid stuff is tough, or completely impossible, on days when the pain hits. Your child may complain about going to school or their favourite play date, so you know something is off.

Attacks typically are short lived - lasting only 1 hour to 3 days. Fortunately, between attacks, children feel and look healthy. That can be weeks or months without any pain or gastrointestinal symptoms.

Triggers may include:

  • Bright or flickering light
  • Poor sleep / fatigue
  • Prolonged fasting
  • School or family stressors
  • Dietary triggers: citrus food, caffeine, cheese, chocolate, carbonated drinks, colorings and flavorings
  • Motion sickness

Tests for abdominal migraines

Like other forms of migraines, other reasons are first ruled out. This may involve your GP referring you to see a paediatrician, neurologist, gastroenterologist or other specialist. This may take months of waiting for appointments and getting results but it's important to make sure the diagnosis is correct.

With abdominal migraines, there is no pathology - there's no visible damage and no positive tests. So - this is great news!

But now what?


Treatments for abdominal migraines

Medication

Medication may be given to stop the pain once an attack starts. If it's really bad and consistent, then preventative medication may be given. This a is similar approach to standard migraines.

Diet

Sometimes dietary changes can help. There's some suggestion that a low FODMAP diet may help "functional gut disorders" like abdominal migraines.

Counselling

Stress may be a contributing factor to abdominal migraines. While stress is a healthy and normal part of life, it can be overwhelming, consistent or cause problems to some. In this case, learning to deal with everyday stresses may reduce the abdominal migraine triggers.

As with any ongoing health concerns, counselling may help to deal with the suffering - missing out on parties, falling behind at school, feel embarrassed about being sick. There's more to pain than the pain itself.

Sleep Assistance

Because fatigue and sleep deprivation can trigger attacks, addressing sleep concerns may be beneficial.


Abdominal Migraines - what now?

Most grow out of their abdominal migraines by their teens. It is common that kids who had abdominal migraines, grow up to have more typical migraines as adults.


What causes abdominal migraines?

Well - we don't definitively know. There are a few theories.

  • Sensitised Nervous System - Individuals with functional gut disorders, like abdominal migraines or irritable bowel syndrome, have quicker responses to painful stimulus. They have a low threshold before the pain nerves are set off.
    This may be due to sensitisation of the sensory or spinal cord nerve cells, changes to anti-pain nerve pathways or impaired stress response.
  • Altered Gut Function - The gut wall may get stretched causing abnormal contractions. Ouch - even sounds painful.
  • Activated Immune System - The immune system has control over the gut-brain axis. Allergies and other disruptions in the immune system may contribute to abdominal migraines.
  • Abnormal neurotransmitter regulation - While driving a car, there's a balance between the accelerator and break. Both are equally important for driving. The same is true of the brain. There's accelerator and break chemicals which should be balanced. An imbalanced system can lead to too much excitation so that the body is more reactive, like in a migraine or abdominal migraine.
  • Genetics - Like typical migraines, abdominal migraines may be genetically passed down to our children. One study found that up to 90% of children with abdominal migraines had a sibling or parent with migraines (Bentley et al. 1995).
  • Sympathetic / parasympathetic imbalance
  • Altered gut microbiome
  • Changes to the hypothalamic-pituitary axis
  • Small intestinal bacterial overgrowth (SIBO)
  • Acute infections with chronic consequences
  • Abnormal cell functions, particularly the mitochondria


Appointments available in Moonee Ponds or online.


Summary:

  • Abdominal migraines involve intense midline or diffuse belly ache with or without a headache.
  • Test results come back negative for other conditions. This is a relief but doesn't provide a solution.
  • We don't know what causes abdominal migraines. It may be a sensitive nervous system, imbalances in brain chemicals, changes in gut bacteria. We are still learning a lot.

About the author:

Cassie is a paediatric sleep consultant. She uses gentle no-cry routines to help establish better sleep for infants, toddlers and preschoolers. She's also a Chiropractor who is passionate about family health, in particular looking at the body-brain connection.


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References

  • 1.6.1.2 Abdominal migraine [Internet]. ICHD-3 The International Classification of Headache Disorders 3rd edition. [cited 1 June 2020]. Available from: https://ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/
  • Bentley, Donald; Kehely, Anne; Al-Bayaty, Munira; Michie, Colin A (1995). Abdominal Migraine as a Cause of Vomiting in Children: A Clinician's View, Journal of Pediatric Gastroenterology and Nutrition: January 1995 - Volume 21 - Issue - p S49-S51 
  • Brusaferro A, Farinelli E, Zenzeri L et al. (2018). The Management of Paediatric Functional Abdominal Pain Disorders: Latest Evidence. Pediatr Drugs20, 235–247. https://doi.org/10.1007/s40272-018-0287-z
  • Gelfand AA (2015). Episodic Syndromes That May Be Associated With Migraine: A.K.A. "the Childhood Periodic Syndromes". Headache. 2015;55(10):1358‐1364. doi:10.1111/head.12624
  • Mani J, Madani S (2018). Pediatric abdominal migraine: current perspectives on a lesser known entity. Pediatric Health Med Ther. 2018;9:47‐58. Published 2018 Apr 24. doi:10.2147/PHMT.S127210
  • McClellan N, Ahlawat R. Functional Abdominal Pain In Children. [Updated 2019 Dec 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK537298/
  • Turco R, Salvatore S, Miele E, Romano C, Marseglia GL, Staiano A (2018). Does a low FODMAPs diet reduce symptoms of functional abdominal pain disorders? A systematic review in adult and paediatric population, on behalf of Italian Society of Pediatrics. Ital J Pediatr. 2018;44(1):53. Published 2018 May 15. doi:10.1186/s13052-018-0495-8