Abdominal Migraine - The Basics Updated

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Under the International Headache Society's International Classification of Headache Disorders, 3rd Edition (ICHD-3) abdominal migraine is a primary headache disorder that falls under the category of episodic syndromes that may be associated with migraine. It's seen mainly in children, but can occur in adults as well.

ICHD-3 Information on Abdominal Migraine

ICHD-3 Description of Abdominal Migraine:

"An idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms, nausea and vomiting, lasting 2-72 hours and with normality between episodes. Headache does not occur during these episodes."

ICHD-3 Diagnostic Criteria:

  1. At least five attacks fulfilling criteria B-D
  2. Pain has at least two of the following characteristics:
    1. midline location, periumbilical or poorly localised
    2. dull or 'just sore' quality
    3. moderate or severe intensity
  3. During abdominal pain at least two of the following:
    1. anorexia
    2. nausea
    3. vomiting
    4. pallor
  4. Attacks last 2-72 hours when untreated or unsuccessfully treated
  5. Complete freedom from symptoms between attacks
  6. Not attributed to another disorder. (1)

Note:
(1) In particular, history and physical examination do not show signs of gastrointestinal or renal disease or such disease has been ruled out by appropriate investigations.

Comments:
Pain is severe enough to interfere with normal daily activities. Children may find it difficult to distinguish anorexia (lack of appetite) from nausea. The pallor is often accompanied by dark shadows under the eyes. In a few patients flushing is the predominant vasomotor phenomenon. Most children with abdominal migraine will develop migraine headache later in life.

Diagnosis of Abdominal Migraine:

As with any form of migraine, there is no diagnostic test to confirm abdominal migraine. Diagnosis is achieved by reviewing both family and patient medical history, evaluating the symptoms, and performing an examination to rule out other causes of the symptoms. Other conditions that should be ruled out to arrive at a diagnosis of abdominal migraine include: urogenital disorders, peptic ulcer, cholecystitis (gall bladder), duodenal obstruction, gastroesophageal reflux, Crohn's disease, and irritable bowel syndrome. If there is any alteration in consciousness, seizure disorders should also be ruled out.

Treatment of Abdominal Migraine:

For infrequent abdominal migraine attacks, medications used for other forms of migraine are often employed. These medications can include NSAIDs, antinausea medications, Midrin equivalent medications, and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal migraines are frequent, the same preventive therapies used for other migraines can be explored.

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Resources:

Headache Classification Committee of the International Headache Society. "The International Classification of Headache Disorders, 3rd edition (beta version)." Cephalalgia. July 2013 vol. 33 no. 9 629-808   10.1177/0333102413485658.

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