Abdominal Migraines Can Be Grueling for Kids

Abdominal migraines are most commonly known by the vomiting and recurring stomach pains that children typically experience. In fact, however, only a small percentage of children experience vomiting with these migraine episodes.

It is rare for adults to have this kind of diagnosis.

James Lance, MD. (1993) says that this type of migraine is most difficult to diagnose and is often dismissed in children. 

A past history of vomiting is given by at least one quarter of his patients, which can occur as part of the migraine attack. 

The statistics show that approximately 20 percent of children experience stomach pain as part of their migraine attack and 25 percent experience vomiting. That still sounds quite a bit to me.

Typical Symptoms of Abdominal Migraines

The most typical symptom is stomach pain that leads to nausea and vomiting. It can occur without an actual headache. If they do have a headache, the pain usually comes and goes within a few hours.

So for children, it may be best to keep them at school in the sick bay while they recover and then they can just go back to class.

However, those two or three hours could be grueling. So it’s up to you really.  The bad news is that, children that have abdominal migraines in their childhood will most likely develop full migraine headaches in their adulthood.

In some cases the moderate to severe "mid-line abdominal pain"  that accompanies these attacks can last for one to seventy-two hours. You will need to learn your child's pattern for a bit, before you know the best way to help them through it.

Along with the stomach pain and other symptoms mentioned like nausea and vomiting, your child may also experience flushing or pallor.

This type of migraine is "usually treated with anticonvulsant drugs” along with anti-nausea medications to take before or during the attack.

The Basics

Abdominal Migraine little girl
  • Rare in adults – 2% of all children may experience abdominal migraines
  • nausea and vomiting is common without accompanying headache pain
  • Girls are affected more than boys
  • A family history is common
  • Will develop into migraine headaches in adulthood
  • Are in reaction to a trigger
  • Typical symptoms are: acute or severe pain in stomach near navel or mid-line of body, nausea, flushing or pallor, cramping, vomiting and  unable to eat
  • The abdominal pain may last for one to seventy two hours (which is up to three days)
  • Attacks are sudden – they can occur without warning

Now you see how similar to say a stomach flu bug this appears to be. Sudden attacks, hot flushing or cold chills, vomiting or not, headache or not.

It can be a puzzle for your Doctor, so don't expect yourself to pick it right away.

And I don't know how many times I've heard a parent say "I thought they were lying to get out of gym class." I am saying this so you can be more gentle on yourself - OK?

The Cause is Still Unknown

Abdominal Migraines Can Be Grueling for Kids

The cause remains elusive, obscure and well - unknown.
 
There are many theories, but the theory that makes the most sense to me is about the chemical changes in the body, either from stress or food triggers.

The chemicals that effect the abdominal region are thought to be caused by are our natural ones - histamine and serotonin.

“Histamine is synthesized in all tissues, but is particularly abundant in skin, lung and gastrointestinal tract. Mast cells, which are present in many tissues, are a prominent source of histamine, but histamine is also secreted by a number of other immune cells.”

And “approximately 90% of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements.”

Therefore, both of these chemical changes could potentially contribute to both abdominal pain and migraines. There is also some evidence to support that daily stress and anxiety can cause fluctuations in these body chemicals. Support for these findings around psychological triggers is growing.

Plus there is a lot of research being done on the gut - brain connection in the nutrition world that is slowly becoming more accepted by mainstream medicine. Especially those who work with children.

Common food triggers for migraines like: chocolate, Chinese food, and processed meats that contain nitrites, are also thought to be the culprit to trigger these migraines as well.

Silly eating habits that children have (hmmm.....and adults) like excessive air intake whilst eating or say swallowing too much air (soup, talking) that causes bloating, may also trigger abdominal migraines or instigate other gastrointestinal symptoms.

Diagnosis and Treatment

It may prove difficult for Doctors to diagnose childhood migraines especially if you and your child are not familiar with the symptoms. They so closely resemble ordinary stomach aches, stomach flu, and other gastrointestinal disease.

Knowing if there is family history of migraine and abdominal migraines will play a key factor the diagnosis. There is abdominal migraine treatment available.

Don’t be alarmed if the Doctor orders a range of tests in order to rule out other causes of the stomach pain. Hopefully your Doctor will be knowledgeable about headaches in children and migraines in children.

If you’d like to keep a written record of symptoms, previous activities and foods eaten – that might be helpful. Whatever you can remember is often useful. Here are some of the things your Doctor might ask about:

  • how long the sudden and severe stomach, or mid-line pain symptoms last
  • if nausea and vomiting accompany episode
  • is there a decrease in appetite or an inability to eat
  • did you notice excessive yawning, fatigue, or lethargy
  • headache
  • paleness or flushing

As the cause of abdominal migraines is still mostly unknown, your Doctor might treat them like a classic or common migraine, and prescribe serotonin blockers and tricyclic antidepressants.

Antidepressants are commonly used for childhood migraines as prevention and they will also help, potentially, with the emotional side effects of having to live with recurring migraine attacks.

This post Migraine in Children: Managing Their Emotional Side Effects, covers more.  

Two oral triptan medications are now approved for kids:

  • Almotriptan 12-17
  • And Rizatriptan 6 – 17 are both on label.

The family of triptan drugs and Valproic acid are proven to assist adults with pain reduction in abdominal migraine cases. As both drugs have only some success, it might be trial and error before you find what works. Try to persevere with them, as any pain relief is good.

Even if you choose not to take them, at least you will know if they work for you or not, should you change your mind. Work with your Doctor every step of the way, to find your best solution.

Alternative Treatments That Work

Biofeedback devices work well with children, or should I say children work well with biofeedback therapy.

These alternatives like biofeedback for migraines and home remedies for migraines in kids over 5 have quite a good track record now. 

Your doctor may also be able to refer you to a good therapist for migraine support and pain counseling in your local area.

I think learning coping skills with this long term condition is essential to maintaining greater health and well-being.

This combination works for me, so give one or a combination of a couple things a read:

You might also like these meditation CD's - I use them over and over and over again! They help calm me down and put me to sleep, which is still the best way to deal with a migraine. If your child can have a deep sleep, it might be all they need.



References:

1. Lance, James W. MD. (1993) Migraines and Other Headaches. Compass Publishing Co. Pty. Limited, Australia. p. 46.
2. National Headache Foundation NHF (2011) Headache Topic Sheet: Abdominal Migraines [Online], Available at: www.headaches.org/education.
3. Webmd.com (2010) Abdominal Migraines in Children and Adults. [Online], Available at: http://www.webmd.com/migraines-headaches/abdominal-migraines-children-adults. Accessed Jan 2012.
4. Stafford, D. and Shoquist, J. MD. (2003) Migraines for Dummies. Wiley Publishing, Inc: New York. p.54.
5. Bowen, R. (2008) Histamine and Histamine Receptors [Online], Available at: http://www.vivo.colostate.edu/hbooks/pathphys/endocrine/otherendo/histamine.html.
6. Wikipedia (updated 10 Jan 2012) Serotonin [Online], Available at: http://en.wikipedia.org/wiki/Serotonin.


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With this new information, what one thing can you do now to reduce your attacks?