Causes of Abdominal Migraine
Abdominal migraine is a primary neurological disorder with a multifactorial etiology involving genetic predisposition, neurovascular mechanisms, and dysfunction of the gut-brain axis, rather than having a single identifiable organic cause. 1, 2
Genetic and Familial Factors
- A strong family history of migraine headaches is the most consistent finding in abdominal migraine, with the majority of affected patients having first-degree relatives with migraine. 3, 4, 5
- The genetic susceptibility appears similar to that of traditional migraine headaches, suggesting shared pathophysiological mechanisms. 1
Neurological Mechanisms
- Abdominal migraine represents a variant of migraine disorder where the primary manifestation is abdominal rather than cranial pain, involving similar neuropeptides, neurotransmitters, and brain pathways implicated in traditional migraine. 1, 2
- The condition involves dysfunction of the autonomic and enteric nervous systems, leading to visceral hypersensitivity and altered pain processing. 1
Gut-Brain Axis Dysfunction
- Chronic inflammatory responses with inflammatory and vasoactive mediators passing into the circulatory system may trigger abdominal migraine episodes through gut-brain axis mechanisms. 1
- Intestinal microbiota modulation of the enteric immunological milieu has been postulated as a contributing mechanism, though this requires further elucidation. 1
Associated Gastrointestinal Factors
- Several gastrointestinal disorders have been linked to migraine occurrence, including Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, and alterations in intestinal microbiota. 1
- However, abdominal migraine is diagnosed specifically when extensive gastrointestinal workup reveals no organic pathology, distinguishing it from secondary causes of abdominal pain. 2, 4
Clinical Context
- Abdominal migraine should be considered when recurrent, severe abdominal pain occurs with normal gastrointestinal investigations, particularly in patients with personal or family history of migraine. 4, 5
- The condition is most commonly seen in children aged 7-12 years, with girls affected more often than boys, though adult cases are increasingly recognized. 5, 4
Important Caveat
The precise mechanisms and pathways related to the gut-brain axis in abdominal migraine remain incompletely understood, and there is no objective non-clinical standard for diagnosis—the condition is identified primarily through clinical criteria and exclusion of organic disease. 1, 2