ABDOMINAL MIGRAINE
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.