What are abdominal migraines?

From the Guidelines

Abdominal migraines are recurring episodes of moderate to severe abdominal pain that occur primarily in children, though they can affect adults as well, and are believed to share the same underlying mechanisms as traditional headache migraines. These episodes typically last between 1-72 hours and are centered in the middle of the abdomen around the navel. Besides pain, symptoms often include nausea, vomiting, loss of appetite, and paleness. The most recent and highest quality study on the management of functional dyspepsia, which includes abdominal migraines, is from 2022, published in the journal Gut 1. According to this study, treatment typically involves both preventive and acute approaches. For acute episodes, NSAIDs like ibuprofen or naproxen can help manage pain, while anti-nausea medications such as ondansetron may relieve associated symptoms. Some key points to consider in the management of abdominal migraines include:

• Regular exercise and lifestyle changes, like avoiding certain foods that may trigger symptoms, will be helpful for some patients.
• All patients with abdominal migraines should be offered a stool test or breath test to look for a stomach infection called H. pylori.
• Patients who test positive for H. pylori should receive a short course of antibiotic treatment for the infection to see if their symptoms improve.
• Patients who test negative, or patients who test positive but whose symptoms continue after antibiotics, should be offered other medications to treat their symptoms.
• Psychological or behavioural therapies may be beneficial for treating symptoms in abdominal migraines, as they use the fact that our brain and upper gut nerves are connected and can influence each other. The British Society of Gastroenterology guidelines recommend a multidisciplinary team approach for managing severe symptoms that do not respond to any of the treatments discussed above 1. It is essential to note that abdominal migraines are part of a spectrum of periodic childhood syndromes and may evolve into traditional migraines as children grow older. Overall, the management of abdominal migraines requires a comprehensive approach that takes into account the patient's symptoms, medical history, and lifestyle, and involves both preventive and acute treatments.

From the Research

Definition and Characteristics of Abdominal Migraines

• Abdominal migraine (AM) is a syndrome characterized by episodic attacks of severe abdominal pain and vasomotor symptoms, nausea, and vomiting 2.
• It is a poorly understood disorder, but the publication of AM diagnostic guidelines by the International Headache Society and the recognition of AM in the Rome Classification of functional gastrointestinal disorders have helped to legitimise this disorder and facilitate research 2.
• Abdominal migraine is relatively common, affecting up to 4% of the pediatric population, and whilst it is not believed to continue into adulthood for the majority of children, it has the propensity to develop into probable migraine and recurrent abdominal pain in adulthood 2.

Diagnosis and Treatment

• Abdominal migraine should be considered a possible source of incurable abdominal pain in adults when accompanied by a complete gastrointestinal workup with normal results 3.
• Patients with abdominal migraine often respond to prophylactic migraine therapies, including calcium channel blockers, β-blockers, topiramate, and antihistamines; a few respond to abortive sumatriptan therapy 3, 4.
• A trial of topiramate as prophylactic therapy is recommended if abdominal migraine is the likely source of the pain 3.
• Avoidance of triggers and prophylactic treatment are currently recommended when an episode begins, but the pathophysiology of this condition remains unclear and treatment for this condition is suboptimal 2, 4.

Comparison with Other Migraine Treatments

• The effectiveness of nonanalgesic migraine therapy, such as pizotifen, propanolol, cyproheptadine, and the triptans, in abdominal migraine has been reported 4.
• A combination of acetaminophen, aspirin, and caffeine was found to be significantly more effective than sumatriptan in the early treatment of migraine in some studies 5.
• Triptans and nonsteroidal antiinflammatory drugs (NSAIDs) have the best levels of evidence and are recommended as the first-line medications for acute migraine attacks, including abdominal migraine 6.