Abdominal migraine

Abdominal migraine causes severe pain in the abdomen, usually in the periumbilical region which is the area around the umbilicus.

Abdominal migraine (AM) is a kind of migraine which causes severe pain in the area of the abdomen. The pain is usually around the navel (belly button) area, which is called the periumbilical area.

It is most common in children starting at about age 7, but younger and older children may also get it. Usually, abdominal migraines stop by the time children become teenagers. However, children who have had them are more likely to have migraine headaches when they are adults. Sometimes adults also have abdominal migraines.

Abdominal migraine causes paroxysmal attacks - attacks that happen suddenly, and happen again and again. The attacks can last from 1–72 hours, but they usually last less than 6 hours. They happen about one-third more often in females than in males.

Abdominal migraines can cause other symptoms along with bad pain in the abdomen. People with AM usually have at least two of these other symptoms: nausea, vomiting, loss of appetite (not wanting to eat), headache, photophobia (being bothered by lights), and pallor (pale skin).

AM is more common in children of women who have had migraine headaches. This suggests that AM may have a genetic cause (a cause that is passed down from parents to their children).

Signs and symptoms

Abdominal migraines can cause many different symptoms. A person having an AM may have all of these symptoms, or only a few.

• Pain in the abdomen which lasts from 1–72 hours
• Loss of appetite (not wanting to eat)
• Nausea (feeling like throwing up)
• Vomiting (throwing up)
• Yawning
• Listlessness (not having any energy)
• Drowsiness (feeling very sleepy)
• Pallor (the skin becomes pale (lighter in color than usual)
• Flushing or skin blushing (the skin of the face, neck, or upper chest suddenly becomes redder. This happens when the body makes more of the hormone adrenaline, which causes the heart to beat faster and pump more blood through the body's blood vessels. The blood vessels also dilate (become larger))
• Dark circles under both eyes

Diagnosis

Diagnostic Criteria of Abdominal Migraine (Rome III Pediatric Criteria)

Must include all of the following:

1. Sudden attack of strong, pain around the navel that lasts 1 hour or more
2. Health is good between attacks and may last weeks to months between attacks
3. The pain makes it hard to do normal things a person does everyday.
4. There is 2 or more of the following symptoms:
5. There are no other medical problems that can be found for the persons symptoms

A. A loss of appetite and/or an inability to eat.

B. Nausea

C. Vomiting

D. Headache

E. Photophobia: this is a sensitivity to light which means light hurts a person's eyes

F. Pallor: this is when the skin becomes pale or lighter than usual because of a medical problem

Note: A person needs to have at least 2 or more attacks of abdominal migraine symptoms in the last year

Adapted from the Rome III Functional Gastrointestinal Disorder Child/Adolescent Committee 2006

Diagnostic Criteria of Abdominal Migraine (ICHD-II)

Diagnostic criteria:
A. At least 5 attacks fulfilling criteria B-D:
B. Attacks of abdominal pain lasting 1–72 hours (untreated or unsuccessfully treated)
C. Abdominal pain has some of the following characteristics:

• midline location, periumbilical or poorly localised
• dull or "just sore" quality
• moderate or severe intensity
• anorexia
• nausea
• vomiting
• pallor

D. Not attributed to another disorder
Note: In particular, history and physical examination do not show signs of gastrointestinal or renal disease or such disease has been ruled out by appropriate investigations.

To diagnose abdominal migraine, first a doctor takes a patient's clinical history (where the doctor gathers information about the medical problems and medical treatments the patient has had). The doctor also takes a family history (gathering information about family members' health), because many medical problems may be inheritable medical conditions. This means that the problems may be passed down from parents to children, possibly because of problems in the family's genes. Most people with abdominal migraines have family members (especially mothers) who have also had migraines.

Differential diagnoses

Before making a final diagnosis of abdominal migraine, a doctor must rule out differential diagnoses. These are other medical problems which could cause the same symptoms. The doctor must make sure that the patient doesn't actually have one of these other problems:

• Giardia lamblia - a parasite which can infect a person's gastrointestinal system
• Lead poisoning
• A tumor
• A peptic ulcer
• Mesenteric adentis - (inflammation, or swelling, of the lymph nodes below and to the right of the navel (belly button)
• Irritable bowel syndrome
• Constipation
• Superior mesenteric artery (SMA) syndrome
• Splenoptosis or 'Wandering spleen'
• Recurrent pancreatitis - inflammation of the pancreas that keeps happening