From the Guidelines
Abdominal migraines are a type of episodic disorder characterized by recurrent episodes of abdominal pain, often accompanied by other symptoms such as nausea, vomiting, and pallor, as mentioned in the context of other medical causes of abdominal pain 1.
Key Characteristics
- These episodes typically last between 2-72 hours, although the exact duration is not specified in the provided evidence.
- Pain is often described as midline, periumbilical, and of moderate to severe intensity.
Diagnosis and Treatment
- The diagnosis of abdominal migraines can be challenging and may be empirical, especially when there is no definite histological confirmation of a disease process 1.
- Treatment may involve the use of anti-migraine medications, although the provided evidence does not specifically discuss the treatment of abdominal migraines.
- It is essential to consider other medical causes of abdominal pain, such as familial Mediterranean fever, angio-oedema, and lead poisoning, as mentioned in 1.
Important Considerations
- Abdominal migraines are distinct from other conditions, such as chronic small intestinal dysmotility, which may present with similar symptoms 1.
- A definitive diagnosis should only be given if there is a clear cause identified, and a premature or erroneous organic diagnosis may make management of contributing issues difficult 1.
From the Research
Definition and Characteristics of Abdominal Migraines
- Abdominal migraine is a syndrome characterized by recurrent stereotypic episodes of paroxysmal abdominal pain and nausea and/or vomiting with wellness between episodes 2.
- It is often associated with a positive family history of migraine and no other apparent underlying disease 2.
- Abdominal migraine and cyclical vomiting syndrome are characteristic syndromes which have overlapping characteristics with migraine but lack the cardinal symptom of headache 3.
- Both abdominal migraine and cyclical vomiting syndrome are characterized by recurrent attacks of nausea, vomiting, and/or abdominal pain lasting hours to a few days, with symptom freedom between attacks 3.
Diagnosis and Epidemiology
- Abdominal migraine is an under-diagnosed cause of chronic, recurrent, abdominal pain in childhood in the USA 4.
- Chronic, recurrent abdominal pain occurs in 9-15% of all children and adolescents, and abdominal migraine represents about 4-15% of these cases 4.
- The International Classification of Headache Disorders--(ICHD-2) defines abdominal migraine as an idiopathic disorder characterized by attacks of midline, moderate to severe abdominal pain lasting 1-72 hours with vasomotor symptoms, nausea and vomiting 4.
- Abdominal migraine affects 0.2% to 4.1% of children and is a type of functional abdominal pain disorder 5.
Treatment and Management
- Patients with abdominal migraine may benefit from prophylactic treatment with propranolol or cyproheptadine 2.
- Treatment is focused on preventive measures and mostly includes nonpharmacologic approaches, with possible pharmacologic treatments including abortive medications used for migraine headaches such as analgesics and antiemetics 5.
- Accurate diagnosis and patient education are crucial for physicians in recognizing abdominal migraine as a differential diagnosis in cases of long-standing recurrent abdominal pain 6.