INTRODUCTION

  • Refers to pain in abdomen severe enough to interfere with normal daily activities.
  • This is a diagnosis when all other serious conditions are excluded.
  • Called migraine after it was noticed to be common in families suffering from either an abdominal or head migraine.
  • Children with an abdominal migraine have the tendency to develop a migraine (head) when adults.
  • Common in children five-nine years old.

SYMPTOMS

  • Pain abdomen which lasts 1–72 hours
  • Anorexia/ Nausea
  • Vomiting
  • Drowsiness
  • Pallor
  • Flushing

DIAGNOSTIC CRITERIA

At least 5 attacks fulfilling below criteria

  • Attacks of abdominal pain lasting 1-72 hours (untreated or unsuccessfully treated)
  • Abdominal pain has all of the following characteristics:
    • Mid line location, periumbilical or poorly localized
    • Dull or ‘just sore’ quality
    • Moderate or severe intensity

During abdominal pain at least 2 of the following:

  • Anorexia
  • Nausea/ vomiting
  • Pallor

TRIGGERS

  • Stress
  • Fasting and skipping meals
  • Changes in sleep pattern
  • Bright lights
  • Foods:
    • Chocolate
    • Cheese
    • Citrus fruits
    • Chinese foods, particularly if it contains mono sodium glutamate
    • Preserved meats

DIFFERENTIAL DIAGNOSIS

  • Constipation
  • Mesenteric adenitis
  • Peptic ulcers
  • Irritable bowel syndrome
  • Appendicitis
  • Renal colic
  • Pancreatitis

MANAGEMENT

Rule out other causes

  • Sleep typically brings relief from abdominal migraine.
  • Medications used to treat classic migraine can also be effective, although there is no single treatment that is known to be effective in all patients.
  • Analgesic drugs, such as non steroidal anti-inflammatory or acetaminophen
  • Sumatriptan in older children with abdominal migraine
  • Tricyclic antidepressants for long term management
  • Valproic acid ( after discussion with specialist)
  • Cyproheptadine has been shown to be effective in some
  • Anti emetic drugs to control vomiting.

 

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