Abdominal migraine is an idiopathic disorder (one in which a cause cannot be identified) seen mainly in children. The symptoms are recurrent episodes of pain in the middle of the abdomen (belly), with attacks lasting 1 to 72 hours and complete normality between episodes.
Last updated November 2014 by Dr M Thomson, Consultant Paediatric Gastroenterologist, The Children’s Hospital Sheffield, Sheffield Children’s NHS Foundation Trust, Sheffield, UK.
The episodes of pain are of moderate-to-severe intensity and are felt in the midline of the abdomen, usually around the belly button, or poorly localised (all over the abdomen). The attacks of pain are usually accompanied by little desire to eat and nausea (feeling of sickness). Approximately half of those affected will vomit with at least some attacks. Other symptoms can include photophobia (sensitivity to light), phonophobia (sensitivity to sound) and dizziness. Children may seem pale, although some children may appear flushed during an attack.
The symptoms of abdominal migraine normally appear in childhood before puberty, reaching a peak at the age of 12 years and thereafter falling rapidly. In people affected the symptoms of abdominal migraine will resolve with age, but in one third of patients the symptoms will persist until the teenage years. Most patients will develop migraine headaches (see entry Migraine). Very occasionally the onset of symptoms may be during the teenage years or in adults
The onset of attacks of abdominal pain may be at any time of day but occur most frequently first thing in the morning on waking. The attacks are self-limiting (eventually will stop) and resolve without treatment and patients are completely well and symptom free between attacks.
Abdominal migraine is an idiopathic condition, which means that in most cases it is not known why it occurs. A family history of migraine is frequently seen in abdominal migraine and as with other forms of migraine. In those susceptible to attacks, eating cheese and chocolate and taking caffeine can cause abdominal migraine.
Recurrent abdominal pain is a common problem in children, although most do not have abdominal migraine. The diagnosis should only be used where the specific features of the condition are present. Doctors may arrive at a diagnosis of abdominal migraine once other conditions causing similar symptoms have been excluded. Some research has suggested that there is a change in brain wave recordings when there is photic (flash light) stimulation of the eyes in those with abdominal migraine. However in the large part, this is not used as a method of diagnosis.
Acute attacks of abdominal migraine are usually treated by rest and the condition frequently resolves with sleep. Patients should be allowed to lie down undisturbed in a quiet and dark room. Simple analgesic (pain-relieving) drugs may be helpful in relieving attacks.
There is good evidence from a controlled clinical study that pizotifen may reduce the frequency and intensity of attacks when given regularly to prevent attacks. In some cases, resolution of symptoms with treatment using pizotifen can confirm a suspected diagnosis of abdominal migraine. It has been suggested that propranolol may also be effective but no controlled clinical trials have been carried out.
Occasionally a one off trial of intra-nasal sumatriptan might be helpful to stop an attack, and, if successful in treating the symptoms, may establish the diagnosis as that of abdominal migraine.
A family history of migraine is frequently seen in abdominal migraine and as with other forms of migraine. The condition appears more commonly to be inherited from the mother, although no firm genetic basis has been identified.
Information and support in the UK for abdominal migraine is provided by the Migraine Action Association and the Migraine Trust (see entry Migraine).