All about Abdominal Migraines

Abdominal migraine is a common cause of chronic abdominal pain, most often seen in children. The condition affects approximately 4% of children and occasionally adults, although it is more rarely seen in adults. The condition can be difficult to diagnose as the symptoms can be similar to those of other conditions.

What are abdominal migraines?

Abdominal migraines are different to regular migraines. They make your stomach ache rather than your head, but they are often as a result of the same triggers as migraine headaches, and are often accompanied by other migraine symptoms, for example, nausea, sickness and sensitivity to light or sound. The person is usually well otherwise, with no indication of the symptoms being related to another condition.

Abdominal migraines can be painful and cause nausea, cramps and vomiting. The pain is usually located in the middle of the stomach, around the belly button area.

An abdominal migraine can last anywhere from 1 to 72 hours, according to the National Institute of Neurological Disorders and Stroke, and a person does not have any symptoms between their migraine episodes.

Who is affected by abdominal migraines?

The condition usually affects children. It affects approximately 4 in 100 children and some adults. Researchers think this estimate might be low, as the condition may be underdiagnosed.

The average age of diagnosis is between 3 and 10 years old with it most often occurring at around 7 years old. Most children have a family history of migraines. Children who are diagnosed with abdominal migraines appear to outgrow the condition. The condition is also more common in females than in males.

Some adults suffer from abdominal migraines, although migraines associated with headaches are more common in adults. Even though the symptoms are different, the diagnosis and treatment of abdominal migraine in adults are very similar to those of migraine headaches. Adults can experience them in isolated cases and sometimes even in addition to migraine headaches.

What are the symptoms of abdominal migraines?

The main symptom of abdominal migraine is abdominal pain, usually in the middle of your abdomen around the belly button. The pain is usually moderate to severe. Unlike other types of migraine, abdominal migraine does not usually cause headaches.

Abdominal migraine symptoms usually start suddenly and end abruptly, usually lasting no more than 72 hours.

Other symptoms of abdominal migraine include:

• Loss of appetite.
• Nausea.
• Vomiting.
• Diarrhoea.
• Loss of appetite.
• Headache.
• A pale appearance.
• Sensitivity to light.
• Sensitivity to noise.
• Fatigue.

People do not usually have symptoms in between episodes and the frequency of the symptoms can vary from person to person.

The symptoms of an abdominal migraine are similar to those of many other childhood gastrointestinal conditions, which are conditions which involve the digestive system. The difference is that abdominal migraine symptoms are not prolonged and come and go with days, weeks or even months between symptoms. Each episode of abdominal migraine is usually very similar and between episodes, symptoms usually disappear completely.

What causes an abdominal migraine?

Researchers into abdominal migraines are unsure exactly what causes them to occur. Many people who suffer from abdominal migraines find they occur without any warning signs. The condition could share some of the same risk factors as migraine headaches.

One explanation is that people who suffer from abdominal migraines have an overly sensitive nervous system. Researchers believe that certain genetic and environmental factors may make someone vulnerable to this hypersensitivity.

Children who suffer from abdominal migraines usually start to outgrow the condition around puberty. More than half of children diagnosed with abdominal migraines will no longer have episodes by their late teenage years. However, many children who have abdominal migraines will develop migraine headaches later in life, either in their adolescent or adult years.

A migraine is a headache that can cause a severe pain or a pulsing sensation, usually on one side of the head. It can be accompanied by nausea, vomiting, and sensitivity to light and sound. Migraine episodes can last for hours or even days.

The pain and intensity of a migraine can be so severe that it can interfere with daily life. Women are more likely than men to suffer from migraines, and around 20% of women experience migraines.

For some people, a warning symptom known as an aura occurs before or at the same time as the headache. An aura can include visual disturbances, such as flashes of light, wavy lines or blind spots.

It can also include sensations such as tingling on one side of the face, in your arm or leg and difficulty speaking. Auras are usually to do with your sight. Your speech can also be affected. Some people can feel disoriented and confused, or can even faint, although this is rare.

The most common symptoms related to this type of migraine with an aura include:

• Seeing flashing or flickering lights.
• Seeing coloured spots or lines.
• Seeing zigzag patterns.
• Blind spots.
• Temporary blindness.

Other symptoms which can occur with aura migraines include:

• A numb or tingling sensation in different parts of the body.
• Muscle weakness.
• Feeling dizzy.
• Fainting.

Approximately one in three people who suffer from migraines have this type of migraine. Scientists believe that temporary changes in the chemicals, nerves and blood flow in the brain cause the aura to occur.

Triggers of abdominal migraines

Although medical professionals are unclear about exactly what causes abdominal migraines, knowing some of the triggers can help in preventing them or easing the symptoms.

Triggers of abdominal migraines include:

• Lack of sleep.
• Irregular sleep habits.
• Stress.
• Too much exercise.
• Hunger.
• Skipping meals.
• Dehydration.
• Flickering lights.
• Swallowing excessive amounts of air.
• Travel.
• Motion sickness.
• Eating certain foods – these can include high-amine foods, such as citrus fruits, chocolate, cheese, salami and ham, or food with additives such as flavourings, colourings and monosodium glutamate.
• Too much caffeine.
• Changes in weather.

Risk factors of abdominal migraines

Similar to migraine headaches, abdominal migraines are thought to be caused by neurological issues. There is a recognised relationship between the brain and the gut and although healthcare professionals do not fully understand why abdominal migraines occur, similarly to migraine headaches, abdominal migraines are thought to be caused by neurological issues.

Risk factors for abdominal migraines are thought to be:

• Having a family history of migraines/being genetically predisposed.
• Having an overly sensitive nervous system.

It is important to note that these risk factors have not been proven and further research is needed into abdominal migraines and exactly what causes them.

How are abdominal migraines diagnosed?

Abdominal migraines can sometimes be difficult to diagnose as the symptoms can be similar to other abdominal conditions. Also, because the condition is most often seen in children, they may be unable or find it difficult to describe their symptoms.

As there aren’t any lab tests or scans that can diagnose abdominal migraine, healthcare providers will need a thorough understanding of your child’s symptoms and medical history in order to make a diagnosis.

Other conditions which may cause similar symptoms can include:

• Stomach ulcers – Also known as gastric ulcers, these are sores that develop on the lining of the stomach. The most common symptom of a stomach ulcer is a burning or gnawing pain in the centre of the abdomen. Stomach ulcers are not always painful and some people may experience other symptoms, such as indigestion, heartburn, acid reflux and nausea.
• Irritable bowel syndrome (IBS) – This is a common condition that affects the digestive system. It causes symptoms such as stomach cramps, bloating, diarrhoea and constipation. These tend to come and go, and can last for days, weeks or months at a time.
• Bowel blockage – A large bowel obstruction is a serious condition. It occurs when a tumour, scar tissue or something else blocks the large intestine.
• Colitis – This comes under the umbrella of Inflammatory Bowel Disease (IBD). Inflammatory bowel disease is a group of conditions that primarily affect the colon and small intestine. Colitis is where the large intestine (the colon) becomes inflamed, swollen and ulcerated. This causes many distressing and debilitating symptoms.
• Crohn’s disease – This disease causes people to experience symptoms ranging from stomach cramps, diarrhoea and fatigue to anaemia, fever and weight loss. Crohn’s disease affects the gut and digestive system. It is a lifelong condition that can usually be managed, but it causes some painful and uncomfortable symptoms.
• Cyclic vomiting syndrome – This is a rare disorder that usually begins in childhood. It causes repeated episodes of vomiting and nausea.
• Bladder or kidney conditions.

In order to make a diagnosis, a healthcare professional will:

• Complete a physical examination.
• Review your medical history and your family’s medical history.
• Complete tests, such as an abdominal ultrasound or an X-ray in order to rule out other conditions which may be causing the symptoms.

Abdominal migraines are usually diagnosed in children who meet the following criteria:

• A pain in the middle of the abdomen around the belly button.
• At least five attacks of abdominal pain that each last 1 to 72 hours.
• At least two of the associated symptoms.
• No evidence of another gastrointestinal issue or kidney disease.

Abdominal migraines can be severe enough to keep children out of school for a few days at a time. As the condition may be mistaken for another gastrointestinal disease, children who are misdiagnosed may end up undergoing unnecessary procedures.

Treatments for abdominal migraines

There is no cure for abdominal migraines, therefore treatment focuses on prevention wherever possible and the treatment of the symptoms.

Abdominal migraines can be difficult to prevent completely, as exactly what causes them is unclear. However, you may be able to help prevent your abdominal migraine episodes by avoiding your triggers. The triggers can vary from person to person so it is important to try and work out what your triggers are.

It may be helpful to keep a diary, which can help in identifying what has happened prior to the abdominal migraine occurring and to monitor the symptoms.

Some helpful measures for preventing abdominal migraines can include:

• Managing stress – Having healthy coping skills can help manage stress levels. A type of talking therapy called cognitive behavioural therapy (CBT) can also help with stress management. CBT can help you manage your problems by changing the way you think and behave. It is most commonly used to treat anxiety and depression, but can be useful for a wide range of other mental and physical health problems. Although CBT cannot cure the physical symptoms of the condition, it can help you to cope better with the symptoms.
• Exercising regularly – This is important for improving your brain health, helping to manage your weight, reducing the risk of disease, strengthening bones and muscles, and improving your ability to do everyday activities.
• Ensuring good quality sleep – Good quality sleep is essential for people with abdominal migraine. Having a regular bedtime routine and good sleep hygiene can help prevent sleep disturbances or lack of sleep, which can trigger episodes.
• Avoiding food triggers – Try to identify any foods which may trigger your symptoms and remove them from your/your child’s diet. You could also try to avoid foods with additive flavourings or colourings. Having a nutritious diet with plenty of fibre is also important.
• Avoiding visual triggers – Flashing lights can trigger episodes of abdominal migraine, therefore avoiding these may help.

Your healthcare provider might recommend medication to help ease your or your child’s symptoms.

Medications which may be recommended include:

• Anti-emetics – This is an anti-sickness medication.
• Triptans and ergotamine – This medication can help treat the pain and may help in preventing the onset of abdominal migraine.
• Beta-blockers – This medication may reduce your blood pressure and help prevent an abdominal migraine.
• Non-steroidal anti-inflammatory drugs (NSAIDs) – This medicine is widely used to relieve pain, reduce inflammation, and bring down a high temperature. An example of this medication is ibuprofen.

During an abdominal migraine episode, resting in a dark and quiet place with a cool cloth or ice pack may help resolve the symptoms. Ensure your child is getting enough sleep, eating regular meals throughout the day, and drinking plenty of fluids. If your child is being sick, you should ensure they are having extra fluids in order to prevent dehydration.

Abdominal migraine is not a serious condition; however, it can affect your day-to-day life. Anyone regularly suffering from abdominal migraines is advised to contact their GP, as it is also important to rule out any other conditions. You can also access advice and support from the Migraine Trust.

You should seek medical attention immediately if abdominal migraine symptoms are accompanied by any more serious symptoms, such as:

• Severe vomiting.
• Dizziness.
• Confusion.
• Muscle weakness.
• Chest pain.
• Loss of vision.
• A high temperature.