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All About Abdominal Migraines

Head Pain Rare in This Unusual Syndrome

By Maureen Salamon

Updated January 29, 2009

(LifeWire) - One of the most poorly understood and unusual types of migraines is something known as an "abdominal migraine." This kind of headache disorder doesn't necessarily produce head pain but causes abdominal distress, nausea and vomiting.

Children Most Affected

Classified as a migraine variant, abdominal migraines are most prevalent in ages 5 to 9, although adults can also experience them. Doctors began to recognize this syndrome, over several decades, as a form of migraine, when they realized their young patients usually had a family history of migraine headaches and later grew up to suffer from them as well. In fact, family history remains the key to distinguishing abdominal migraines from the anxiety-related stomachaches that children often experience.

Before puberty, migraine headaches occur equally in boys and girls, but girls endure them at a rate of 3 to 1 after puberty. Regardless, the condition is rare, with less than 2% of children experiencing migraines by age 7 and 5% by age 15.

Abdominal migraines are even more unusual. Only about 1/5 of children with diagnosed migraines suffer from abdominal migraines, according to a study in Pediatric Neurology.

Diagnosis is Long and Tricky

The problem with diagnosing an abdominal migraine lies in the similarity of its symptoms to typical childhood gastrointestinal illnesses, such as a sudden onset of abdominal pain, whether sharp or dull, that is usually near or around the navel, in addition to nausea and repeated vomiting that lasts for just a few hours or up to 3 days. Discomfort leaves as suddenly as it comes, offering no clues as to when it will return.

Sufferers not only feel miserable, but look it too. They can be extremely pale with dark circles under their eyes, and abdominal migraine sufferers have little energy or motivation to engage in normal activities, including eating. Rarely, to top it all off, their symptoms include an actual headache.

Migraine headaches apparently arise when blood vessels and nerves in the brain react abnormally to changes in the body or environment. Often preceded by an "aura" -- a sparkling flash of light, blind spots or zigzag lines in the field of vision -- a migraine headache typically produces intense, throbbing pain behind the forehead and/or eyes. These last for about 4 to 72 hours, forcing sufferers to lie down in dark rooms and shun all activities.

One shared trait between those suffering from migraine headaches and those sufferering from abdominal migraines is sensitivity to certain triggers, such as foods, odors or lights. Stress and hormonal changes may also be involved for both migraine types.

In a 2006 study reported in the journal Psychosomatics, researchers detailed the cases of two adolescent girls afflicted with abdominal migraines. Noting how each girl had absolutely no symptoms between attacks, the study's lead author, Violeta Tan, also detailed how their hospitalizations were preceded by stressful situations, such as a change of school or the death of a boyfriend. Only after numerous hospitalizations were the girls finally diagnosed.

These two girls symptoms were extreme.

"On admission, (one girl) was found curled up in a fetal position and would only nod or shake her head in response to questions," Tan wrote. "One week into her admission, (she) began to demonstrate signs of delirium with agitation, which included striking out at nurses, biting and self-induced vomiting..."

The patients underwent a battery of tests, which can include body imaging scans and abdominal and kidney exams, before being diagnosed with abdominal migraines.

There is no single test that confirms the abdominal migraine condition. A process of elimination must be done first by excluding many other conditions, such as ulcers, irritable bowel syndrome or an obstructed bowel. The same process holds true for repeated stomach pain and vomiting that doctors may later conclude is due solely to stress.

Unfortunately, an accurate diagnosis often takes a long time, sometimes even years, which virtually ensures abdominal migraine sufferers will endure multiple attacks before doctors are able to confirm their cause.

Treating Abdominal Migraines

Successfully treating abdominal migraines can consume even more time before patients experience consistent relief.

Sometimes, in fact, treatment can lead to further problems. Over-the-counter pain relievers such as aspirin, Advil or Motrin (ibuprofen) can prompt abdominal pain and bleeding, especially when taken over a long period of time. Also, once an attack has begun, very little seems to work to abate the pain.

Prescription drugs used to prevent migraine headaches often work for abdominal migraines as well, but doctors take the age of the patient into account when prescribing them. These medications include triptans, which constrict blood vessels and possibly inhibit inflammation; these may include brand names such as Imitrex, Maxalt, Amerge, Zomig, Axert, Frova and Relpax.

Other prescriptions include anti-nausea drugs and the sedative butalbital combined with aspirin or Tylenol (acetaminophen).

In the Psychosomatics study, Tan and her colleagues were successful in using intravenous valproic acid, which is also used to avoid migraine headaches, as well treat epilepsy and bipolar disorder. This was the first such study to demonstrate this success, although the researchers weren't completely sure why the compound worked.

Sources:

Tan, Violeta. "Abdominal Migraine and Treatment with Intravenous Valproic Acid." Psychosomatics 47Aug. 2006. 353-355. 26 Mar. 2008. <http://psy.psychiatryonline.org/cgi/content/full/47/4/353>.

"Migraine." MayoClinic.com. 6 Jun. 2007. Mayo Foundation for Medical Education and Research. 26 Mar. 2008. <http://www.mayoclinic.com/print/migraine-headache/DS00120/M>.

Al-Twaiijri, Waleed. "Pediatric Migraine Equivalents: Occurrence and Clinical Features in Practice." Pediatric Neurology 26. 5 May 2002. 365-368. 26 Mar. 2008. <http://www.journals.elsevierhealth.com/periodicals/pnu/article/PIIS>.

"Migraine Variants for Children." Achenet.org. 2007. American Headache Society. 26 Mar. 2008. <http://www.achenet.org/education/patients/MigraineVariantsChildren>.

LifeWire, a part of The New York Times Company, provides original and syndicated online lifestyle content. Maureen Salamon is a freelance writer who has written for newspaper, website and hospital clients. Her work also appears in the "Chicken Soup for the Soul" book series, and she is co-writing the memoir of the pediatrician who discovered AIDS in children.
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