From the Research
Abdominal migraine is a functional abdominal pain disorder that can be effectively managed with a combination of lifestyle modifications, acute treatment with NSAIDs or antiemetics, and preventive strategies using medications such as amitriptyline, propranolol, or topiramate. The condition is characterized by recurrent episodes of moderate to severe midline abdominal pain lasting 1-72 hours, often accompanied by nausea, vomiting, loss of appetite, and pallor 1.
Diagnosis and Pathophysiology
Abdominal migraine is a clinical diagnosis, with diagnostic criteria outlined under the Rome IV criteria and the International Classification of Headache Disorders III criteria 1. The pathophysiology of abdominal migraine is believed to involve abnormal serotonin metabolism and cortical spreading depression affecting the gut via the gut-brain axis, similar to headache migraines 2.
Treatment Options
For acute episodes, NSAIDs like ibuprofen (10mg/kg/dose) or naproxen (5-7mg/kg/dose) can provide relief, while sumatriptan (oral 25-50mg or nasal 5-20mg) may help in older children [@Example@]. Antiemetics such as ondansetron (0.15mg/kg/dose) can manage nausea. For prevention in frequent or severe cases, amitriptyline (starting at 0.25-0.5mg/kg/day, increasing gradually), propranolol (0.5-2mg/kg/day divided twice daily), or topiramate (starting at 0.5-1mg/kg/day, increasing gradually) may be prescribed 3, 4.
Lifestyle Modifications
Lifestyle modifications are equally important, including regular sleep patterns, meals, hydration, stress management, and identifying potential triggers like certain foods, stress, or lack of sleep 1. Abdominal migraines are believed to share pathophysiology with headache migraines, and most children with abdominal migraines eventually develop typical migraine headaches as they grow older, suggesting a developmental continuum of the condition 2.
Key Considerations
It is essential to recognize abdominal migraine as a legitimate condition, as it can significantly impact the quality of life of affected individuals 2. A comprehensive treatment plan that incorporates both pharmacological and non-pharmacological approaches can help manage symptoms and improve outcomes 1, 4.