When you think of migraines, headaches probably come to mind. A migraine is a neurological condition that can lead to nausea, vomiting, and sensitivity to light. Its main symptom is excruciating head pain. But, it turns out that this disease can also affect the abdomen, especially in children.
“[Abdominal migraines] are quite common and quite underdiagnosed,” says Lindsay Elton, a pediatric neurologist in Austin, Texas. “Families will come in and say they thought their child had a lot of stomach bugs, but it was happening too regularly to make sense.”
What are abdominal migraines?
Abdominal migraines are not like typical migraines. In fact, people with abdominal migraines rarely have headaches. Instead, the pain is located in the belly, usually centered around the navel. It is often described as a pain or pain, like a stomach ache, but it can be different depending on the person.
Abdominal migraines affect 0.2 to 4.1% children. “We tend to see them in young children, usually primary school age, and into early middle school,” Elton says. It’s rare to see them happen earlier, but it does happen.
Abdominal migraine attacks tend to get better as children get older, sometimes disappearing completely. But about 70 percent of children will continue to have classic migraines.
Preteen boys tend to have a higher incidence of migraines, but as children progress through puberty, more girls are affected by migraines and boys tend to grow out of them, according to Elton.
“It would be interesting to know what that looks like with pure abdominal migraine attacks,” says Elton, “[whether] these children have a higher incidence of migraines in girls; I imagine so.
Doctors don’t know exactly what causes abdominal migraines, but the condition could be due to shared neurotransmitter systems in the brain and gut. “Your gut has a huge number of nerve endings and serotonin receptor sites, just like in the brain,” Elton explains. And the same receptor stimulation that happens in the brain with headache migraines probably happens with abdominal migraines, only in the gut.
Diagnosing abdominal migraines
There is no specific diagnostic test for abdominal migraines. Instead, family history, symptoms, and previous tests are all taken into account. There is a family history of migraines in 34 to 90 percent of children with abdominal migraines, according to a 2018 peer-reviewed study dove press .
If a child has not had a gastrointestinal workup, many neurologists will refer them to rule out other possible causes, such as Crohn’s disease, irritable bowel syndrome, and cyclic vomiting syndrome. Gastrointestinal specialists may do an endoscopy, ultrasound, blood tests, or stool studies.
According to International Classification of Headaches 3rd Edition (ICHD-3), to meet the diagnostic criteria for abdominal migraines, a child must have:
At least five attacks of abdominal pain lasting between two and 72 hours
No symptoms between episodes
Two of the following three characteristics: midline or periumbilical location, dull or aching pain, and moderate to severe intensity
Associated symptoms such as lack of appetite, nausea, vomiting or pallor (pale appearance)
The symptoms are not caused by another explanation
“Diagnosis is not a difficult diagnosis. It has clear diagnostic criteria, but you actually have to sit down and take a story from someone,” says Elton.
Managing triggers is key
Good self-care is the best prevention for abdominal migraines. Sleep, nutrition and hydration go a long way in managing symptoms. “Staying well hydrated is of paramount importance,” says Elton. Sometimes the only prescription his young patients walk away with is a daily water intake goal. With these lifestyle changes, she believes half of her patients’ symptoms improve significantly.
Stress is also often a common trigger. There have not been many studies on the use of cognitive behavioral therapy (CBT) to help reduce abdominal migraine attacks in children, but some to research supports CBT for the treatment of migraines in children.
Many children with abdominal migraines also have a significant history of motion sickness, Elton says. Often, toddlers and young children with motion sickness will develop recurring headaches and migraines. “There’s a connection there, but we don’t know exactly what it is,” Elton adds.
Certain foods can also be triggers. Food preservatives such as MSG, dyes (especially red dye) and nitrates seem to cause migraines, as well as tyramine, present in parmesan and other aged cheeses. If your child has frequent episodes, you may consider removing them from their diet for a few weeks, one at a time, and see if the migraine attacks become less frequent or less severe.
Other Ways to Treat Abdominal Migraines
The sooner you can treat migraines, the sooner you can prevent symptoms. Over-the-counter pain relievers such as Tylenol and ibuprofen, or anti-nausea medications can be great options.
Prescription medications for migraines are generally safe and effective. Daily preventative medications are usually reserved for children who have more than four seizures per month, or whose seizures last several days or cause them to miss school, Elton says.
Certain supplements have been reported to have some success in treating migraine symptoms. While magnesium is supported by American Migraine Foundation, it can cause stomach upset, making Elton more hesitant to use it with his patients. Vitamin B2 May Help Prevent Migraine Symptoms According to 2021 Study Nutritional neuroscience to study. According to Elton, there is no data showing its usefulness for abdominal migraines specifically, but it may help some children and it is considered a low-risk drug to try.
Demystifying abdominal migraines and getting a diagnosis is important, Elton says, because it can make the pain less scary and allay parents’ worries about their children. It is also a vital step towards valuable treatment. “Feeling like you’re in control and have a game plan is very helpful,” says Elton.