What Is an Abdominal Migraine?

What Is an Abdominal Migraine?

The International Headache Society defines an abdominal migraine as an idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline (center) abdominal pain, associated with vasomotor symptoms (hot flashes, flushing, night sweats), nausea and vomiting, lasting 2-72 hours and with normality between episodes. A headache does not occur during these episodes.

An abdominal migraine occurs mostly in infants, toddlers, children, and teens. Most children with abdominal migraines will develop a migraine headache later in life.

An abdominal migraine is rare, but not unknown, in adults. Other disorders are ruled out first, such as irritable bowel syndrome, lactose intolerance or reflux before an adult is diagnosed with an abdominal migraine, which can take several years.

According to a review done on abdominal migraine,

• Abdominal migraines are usually diagnosed at the age of 3-10 years.
• Early studies by Cullen and MacDonald found that childhood abdominal migraine typically evolved into migraine headaches in adulthood.
• Several studies have linked abdominal migraine to migraine headache in later life and a family history of migraines.
• Children with recurrent abdominal migraine are at risk of impairment of their social and educational development, which places a significant burden on community’s healthcare resources.

What Causes Abdominal Migraines?

It isn’t visible what the cause of abdominal migraines are. Some researchers believe that it is related to neurologic and endocrinologic (hormonal) changes and may be caused by shifts in serotonin levels.

Genetics may also be involved as an abdominal migraine is found in children whose families have a history of migraines.

What Are the Symptoms of Abdominal Migraines?

The most common symptoms of an abdominal migraine are a centralized pain in the abdomen, nausea, vomiting, loss of appetite, and having no head pain. The criteria for diagnosing abdominal migraine according to the ICDH-3 are as follows:

1. At least five attacks of abdominal pain, fulfilling criteria B-D.
2. Pain has at least two of the following three characteristics:
   • Midline location, periumbilical or poorly localized.
   • Dull or “just sore" quality.
   • Moderate to severe intensity.
3. At least two of the following four associated symptoms or signs:
   • Anorexia (loss of appetite)
   • Nausea
   • Vomiting
   • Pallor

Pain can be severe enough to interfere with normal activities. Children may find it challenging to distinguish anorexia from nausea. Dark shadows under the eyes often accompany pallor. In a few patients, flushing is the predominant vasomotor phenomenon.

Foods That Trigger an Abdominal Migraine

Many of the foods that commonly trigger migraine headaches also trigger an abdominal migraine. These include:

• Chocolate
• Cheese
• Citrus fruits
• MSG (monosodium glutamate)
• Preserved meats (bacon, hot dogs, lunch meats)
• Alcohol

It is a good idea to keep a headache journal to keep track of what foods were eaten and if an attack occurred afterward. Identifying and avoiding food triggers will help to lessen the frequency of attacks.

Other triggers that may produce an attack are:

• Stress – whether it is positive (excitement about an upcoming trip) or negative (worry over an exam), both can be a trigger
• Fasting or skipping meals
• Changes in sleep habits
• Bright, flickering or glaring lights
• Exercise (for some people)

Abdominal Migraine Treatment

There is little evidence available to base recommendations for the drug management of abdominal migraines. The small amount of literature available suggests that the antimigraine drugs pizotifen, propranolol, and cyproheptadine are effective prophylactics.

The treatment of abdominal migraines is usually taken in a two-fold approach – to reduce symptoms and to prevent or lessen future attacks. Some of the medications that have been used to treat patients with an abdominal migraine include:

• NSAIDs (nonsteroidal anti-inflammatory medications) or acetaminophen
• Triptans – nasal sumatriptan may be effective in relieving abdominal migraine in older children
  • Two triptans have been FDA approved to be used in treating children with migraines
    • Maxalt (rizatriptan) is a dissolvable tablet approved for children six years and up
    • Axert (almotriptan malate) was approved for children ages 12 and up
  • Anti-nausea medications – such as Phenergan or Reglan, which also have anti-migraine properties
  • Tricyclic antidepressants and drugs that block serotonin have been used to decrease attacks
  • Depakote (anti-seizure medication)
  • Ergotamine medications – have been used to treat some variants of a childhood migraine
  • Low dose aspirin and low dose beta-blockers – used long-term in some patients to lower the frequency of future attacks
  • Cyproheptadine (anti-histamine) has been shown to be effective in some children

Homeopathic Treatments for an Abdominal Migraine

The following homeopathic treatments could be used to treat an abdominal migraine, under the care of licensed homeopath or naturopath:

• Colocynthis – obtained from the fruit of the bitter apple; it is used for relieving headaches, stomach pain with nausea and vomiting, facial neuralgia, and acute abdominal pain accompanied by diarrhea.
  • Is helpful if there are sharp cutting pains.
• Pulsatilla – this plant helps to treat painful indigestion, nausea, diarrhea, and car and motion sickness.
  • Helps if stomach pain is caused by eating rich, fatty foods.
• Magnesium phosphoricum (phosphate of magnesium) – is used as an anti-spasmodic remedy, treats the cramping of muscles with radiating pain.
  • Helps with cramps and diarrhea.
• Bryonia – obtained from the root of the plant, it is used as an anti-emetic.
  • Can be used if the pain is worse from heat or the slightest movement.

Home Remedies

Treating the symptoms of an abdominal migraine can be done at home as well. Here are a few options you could use:

Anti-Nausea Wristbands

These wristbands provide natural relief from nausea through acupressure. The pressure points P6 (for adults) and H7 (for children) are often targeted.

• Pericardium 6 or P6 (Nei Guan) is located three finger breadths below the wrist in the inner forearm and between the two tendons. It is commonly used to relieve nausea, upset stomach, motion sickness, headaches, and carpal tunnel syndrome.
• Heart 7 or H7 (Spirit Gate) is located at the ulnar end of the distal wrist crease when the palm faces upward. It works well for treating children’s anxiety, nervousness, and nausea.

Essential Oils

Peppermint oil is a natural way to treat nausea. This can be achieved by rubbing a few drops onto the abdomen, putting a drop on the wrists to soothe nausea and motion sickness, or using an essential oil diffuser to inhale it.

Ginger

Sipping on a cup of ginger tea can help relieve nausea. You could either buy a good quality ginger tea or boil slices of ginger root in water with some lemon and honey for several minutes.