What Is an Abdominal Migraine?
Key takeaways:
Abdominal migraines are repeated episodes of severe abdominal pain. They are most common in children between the ages of 3 and 10 years.
One of the best ways to treat abdominal migraines is lifestyle changes that avoid the common triggers. This can include adopting a regular eating and sleeping schedule as well as learning coping mechanisms to manage stress.
Beyond lifestyle changes, there are some medications that can help alleviate abdominal migraine symptoms and decrease how often episodes occur.
Most people think about head pain when they picture a migraine. But there are actually different types of migraines. And not all of them affect the head. Abdominal migraines are a variant of classic migraines — but rather than episodes of headache, they cause episodes of abdominal pain.
They’re more common in children than adults. Experts estimate that about 4% of children experience abdominal migraines, and this may be an underestimate because it can be challenging to diagnose. In this article, we’ll look at the symptoms of abdominal migraines, why they happen, and how to treat them.
What are the symptoms of abdominal migraines?
It can be hard to know if you or your child has abdominal migraines. They’re not a well-known diagnosis, and they can lead to symptoms that many things can cause. There are several symptoms providers use to diagnose abdominal migraines that can help you figure out if they’re happening to you.
The symptoms and characteristics of abdominal migraines include:
Abdominal pain: This can range from dull pain around the belly button to cramping pain all over the abdomen. It’s generally severe enough to keep children from doing their daily activities.
Episodic: There’s usually a sudden start to the abdominal pain, which then goes away between episodes. Each episode generally lasts between 2 hours and 72 hours.
Recurrent: This means the episodes of abdominal pain keep repeating themselves. Episodes are usually separated by weeks to months.
Pallor: More than 90% of children are pale during episodes of pain.
Decreased appetite: About 90% of children do not feel like eating during episodes.
Nausea and vomiting: About 80% of children have nausea during an episode. A smaller number (between 30% and 50%) actually vomit.
Aura: Similar to migraine headaches, sometimes children who have abdominal migraines will have other symptoms before their pain starts. This can include seeing flashing lights or numbness or tingling in their extremities.
Who gets abdominal migraines?
Certain groups are more likely to get abdominal migraines. This includes:
Children: Abdominal migraines are most common in children between the ages of 3 and 10 years old.
Female children: Girls are slightly more likely than boys to have abdominal migraines.
Adults with migraines: As many as 70% of adults who have migraines describe having episodic pain (like abdominal migraines) in childhood. Most of these people no longer have symptoms of abdominal migraines as adults.
Relatives with migraines: Among people with abdominal migraines, 90% have a first-degree relative (sibling or parent) who has migraine headaches.
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Why do abdominal migraines happen?
Scientists do not know for sure why abdominal migraines happen. But they have several theories:
Genetics: Experts have not identified a specific gene that causes abdominal migraines. But if you have a parent with migraines, there’s about a 50% chance that you may also develop migraines of some type (abdominal or classic headache).
More sensitive nerves in the gut: It seems some people may have nerves in the lining of their intestines that may be more sensitive to hormones — like serotonin. This means it may take smaller amounts of hormones for their intestines to react with pain.
Decreased gut motility: Some people may have intestines that move slowly. When food and waste move slower through the digestive tract, it may be uncomfortable and lead to episodes of abdominal migraine.
Psychological factors: Abdominal migraines are more likely to occur in stressful situations. They seem to happen more often in those who also have anxiety or depression.
In addition to identifying potential causes, experts have also observed common triggers for abdominal migraine episodes. These include:
Stress
Poor or disrupting sleep
Periods of fasting (not eating)
Motion sickness
Food additives and food coloring
MSG (monosodium glutamate)
High-amine foods (like chocolate, eggplant, mushrooms, salami, cheese, ham, and citrus)
How do you diagnose abdominal migraines?
Abdominal migraines can be tricky to diagnose because there’s no specific test. Instead, a healthcare provider bases the diagnosis on your symptoms and exam.
To make the diagnosis of abdominal migraines, someone must meet several criteria:
Moderate to severe abdominal pain
At least 2 episodes in 6 months
Episodes include at least two of the following symptoms:
Pallor
Decreased appetite
Nausea
Vomiting
Episodes last between 2 to 72 hours
No symptoms in between episodes
How do you treat abdominal migraines?
There are a number of ways to treat abdominal migraines. We’ll review the two main categories.
1. Lifestyle changes
Lifestyle changes are things in your day-to-day life that you can adjust. The following are treatments that do not require medications:
Rest: It’s important to get enough sleep and keep a regular sleep routine and schedule.
Manage stress: Try to avoid stressful situations as much as possible. You can also make small changes to cope with stress.
Avoid motion sickness: This may mean avoiding long road trips or places at high altitudes.
Establish regular eating habits: Eating at regular intervals will help you avoid periods of fasting that may trigger an episode.
2. Medications
There are several categories of medications that can help. The following medications may help stop the symptoms once an episode has started:
Ibuprofen (Advil, Motrin)
Acetaminophen (Tylenol)
Antiemetics (medications that stop nausea and vomiting)
Sumatriptan (a medication that’s effective in treating migraine headaches)
There are other medications that aim to prevent the episodes of abdominal pain from starting in the first place. Many of them have not been studied in children with abdominal migraines, but they have been used with adult migraine headaches with some success. They include:
Topiramate (a seizure medication)
When should I seek medical attention for abdominal migraines?
If you or your child have the symptoms we described above, it’s best to see your regular healthcare provider. They’ll be able to look closely at your symptoms and do a physical exam to make sure there are no other conditions to consider. They may also refer you to a specialist.
But there are cases when you should not wait for a regular appointment. There are also a number of symptoms that require more urgent medical attention. These symptoms include:
Throwing up blood
Large or increasing amounts of green vomit
Bloody stool
Abdominal pain with fever
Dizziness
Weight loss (losing more than 10% of your body weight)
The bottom line
Abdominal migraines can be a confusing condition, given most people associate migraines with headache. Many people who have abdominal migraines as children will develop migraine headaches as adults. And many of the triggers for the abdominal variant are the same as those for headaches.
It can help to introduce healthy lifestyle routines, like sleeping and eating regularly. While these measures may not completely alleviate symptoms, they can be part of a whole-body approach to decreasing symptoms.
Why trust our experts?
References
Azmy, D. J., et al. (2020). Review of abdominal migraine in children. Gastroenterology & Hepatology.
Napthali, K., et al. (2015). Abdominal migraine. Cephalgia.
Winner, P. (2015). Abdominal migraine. Seminars in Pediatric Neurology.
Woodruff, A. E., et al. (2013). Abdominal migraine in adults: A review of pharmacotherapeutic options. Annals of Pharmacotherapy.
