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abdominal migraineAbdominal Migraine is a migraine syndrome that is prevalent mainly in children between the ages of 3 to 10 years. It is characterized as an acute onset of recurrent episodes of moderate to severe midline abdominal pain accompanied by anorexia, pallor, nausea and/or vomiting. Abdominal migraine attacks typically last anywhere from 2 – 72 hours. The abdominal pain is frequently described as dull or sore, and interferes with daily activities in the majority of patients. The prevalence in childhood ranges from 2.4 – 4.1% and is more common in girls. [1, 2]

Diagnosis and Triggers

A key factor in diagnosing abdominal migraine is the absence of headache as well as less severe vomiting episodes than typically reported in those with cyclical vomiting syndrome (CVS). Moreover, children are symptom-free between attacks. It should also be noted that the onset and resolution of a patient’s symptoms are abrupt. Additionally, behavioral and mood changes or anorexia can proceed the sudden onset. [1] Occasionally, attacks of abdominal migraine are followed by auras involving visual disturbance, flashing lights, slurred speech, and numbness or tingling in the extremities. [3] Episodes of abdominal migraine are usually sporadic, although they have been reported in some children to occur at regular intervals. [3] Attacks can be triggered by stress, skipping meals, dehydration, irregular sleep habits, travel and exercise.

A diagnosis of abdominal migraine requires that other disorders with similar symptoms be ruled out, such as gastrointestinal, urogenital disorders and CNS abnormalities. Gastrointestinal problems include: peptic ulcer disease, cholecystitis, gastroesophageal reflux, gastrointestinal obstructions, Crohn’s disease, and irritable bowel disease. Central nervous system disorders can include posterior fossa tumors if nausea and vomiting are prominent and epilepsy if the abdominal pain is accompanied by altered consciousness. [3, 4]

Abdominal migraine can persist into adulthood and can occur in adults. [5] Abdominal migraine has also been shown to be a precursor to the development of migraine with and without aura. [3, 1] The majority of those with abdominal migraine eventually go on to develop migraine with or without aura.

References:

Abu-Arafeh I, Russell G. Prevalence and clinical features of abdominal migraine compared with those of migraine headache. Arch Dis Child 1995;72:413-7.

  1. Mortimer MJ, Kay J, Jaron A. Clinical epidemiology of childhood abdominal migraine in an urban general practice. Dev Med Child Neurol 1993;35:243-8.
  2. Cuvellier JC, Lepine A. Childhood Periodic Syndromes. Pediatr Neurol 2010;42:1-11
  3. Kabbouche, MA. Childhood periodic syndromes. In: Hershey AD, Powers SW, Winner P, Kabbouche MA, editors. Pediatric Headaches in Clinical Practice. NJ, USA: Wiley-Blackwell, 2009:101-116.
  4. Dignan F, Abu-Arafeh I, Russell G. The prognosis of childhood abdominal migraine. Arch Dis Child 2001;84:415-8.

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