What Is An Abdominal Migraine?

What comes to mind when you hear the term 'migraine'? For most people, a migraine automatically translates to intense head pain (migraine headaches). However, abdominal migraine, better known as stomach migraine, is a condition that causes repetitive stomach aches.

In most cases, this condition affects children aged ten and below but there have been isolated instances of adults experiencing symptoms.

Read on as we share more insights into this condition.

What causes abdominal migraines?

The exact cause of stomach migraines remains a mystery. However, medical experts have presented several theories explaining the cause of this condition, including:

• Changes in the trigeminal nucleus: A study¹ has suggested changes in activity in the part of the brain that controls pain

• Genetics: A 2018 study² found that if a parent or other family member has a history of abdominal migraines, there's a chance of the children having them too

Other possible causes of stomach migraines include:

• Food allergies

• Excitement or stress

• Sleep deprivation

• Exposure to bright or flickering lights

• Motion sickness

• Exhaustion

• Swallowing excess air

It can be challenging to cope with an illness whose cause isn't precisely known. Keeping a journal detailing what triggers stomach aches is a great start.

Diet and abdominal migraines

Scientific evidence² has linked this type of migraine to what you or your children eat.

Some of the foods responsible include:

• Excess coffee

• Red wine

• Chocolate

• Citrus fruits

• Artificial sweeteners like those in diet sodas

• Foods rich in monosodium glutamate (MSG), such as fast foods

• Processed meats

• Some artificial sweeteners, such as aspartame

• Tyramine, common in aged cheeses

• Nitrate-rich foods, such as cold cuts

Certain foods may affect you or your child differently from anyone else. Keeping a food diary can help to keep track of food triggers.

Abdominal migraine symptoms

The first and dominant sign is bouts of stomach aches. The pain is mainly around the belly button, or as the doctors call it, midline abdominal pain. This pain can range from moderate to intense and lasts 2–72 hours.³ Your child can be in such severe pain that they won't be able to go about their usual activities.

Apart from the pain, your child might also exhibit:

• Diarrhea

• Vomiting (easy to confuse with cyclical vomiting syndrome)

• Pale skin

These symptoms are usually absent after an episode, and your child will go back to their usual self. It is common to confuse a stomach migraine in children with familiar bellyache triggers, such as Crohn's disease and irritable bowel syndrome (IBS).

Abdominal migraines in children

Stomach migraines are more common in children than adults. The condition occurs in 11%–15%² of children and adolescents (an overall prevalence of 1%–9%). While children aged 4–15 years are most at risk, the average diagnosis age is 3–10 years. The disorder is at its peak when the child is seven years old and may affect more girls than boys.⁴

There's conflicting evidence supporting gender prevalence. Some studies⁴ suggest girls are most at risk of stomach migraines. The pain can be debilitating, and your child won't be able to attend school or play.

The condition will likely fade as your child grows. In most cases, children outgrow the condition by adolescence.⁵ However, 70% of children⁶ suffering from abdominal migraines might develop headaches later.

If you suspect your child has this condition, consult your doctor early on for a proper diagnosis.

Abdominal migraines in adults

Although stomach migraines primarily affect children aged 3–10 years,  adults are also at risk, albeit to a lower degree.

However, there have been cases⁷ supporting the prevalence of this condition in adults, including studies involving a 58-year-old⁷ and a 52-year-old.⁸ 

Abdominal migraines in adults tend to be undiagnosed or misdiagnosed. It's common to treat an adult who presents with these symptoms for:

• Irritable bowel syndrome (IBS)

• Functional dyspepsia (FD)⁹

• Other gastrointestinal disorders

• Mental disorders (especially when the patient presents with anorexia)

How to diagnose abdominal migraines

Children tend to be less articulate about their symptoms, so these migraines can often go undiagnosed or misdiagnosed in younger people. Symptoms in children are sometimes different from adult migraines, which can also lead to a lack of diagnosis. 

For both children and adults, the most definitive way to diagnose this disorder is through family history. If you or your child has it, one or both parents may also have (had) it.

After conducting a physical exam, your doctor will likely consider several other conditions that can cause similar symptoms before diagnosing abdominal migraine.

Some possible tests include abdominal ultrasound, endoscopy, and blood and urine tests to rule out conditions such as:

• Celiac disease

• Inflammatory bowel disease

• Kidney stones

• Urinary tract infections (UTIs)

• Crohn's disease

• Viral infections

• Gastroesophageal reflux (GERD)

• Porphyria

• Sickle cell disease

Prevention, treatment, and management

Prevention

An abdominal migraine can be a challenging experience for the sufferer, and it can be difficult to watch your child go through the ordeal. Understandably, this condition might weigh you down as it can affect multiple aspects of your life or your child’s life.

Here are a few preventive measures you can take:

• Preventative medications that your child needs to take daily for the best outcomes include propranolol and anticonvulsants, such as topiramate (for children above 12 years according to FDA protocols). In one study,¹⁰ the drug was recommended for pharmacotherapy in adults.

• Avoid all triggers, as discussed above

• Monitor diet and stay hydrated

• Keep track of symptoms. Use a journal or app to track your or your child's condition. If possible, encourage your child to maintain their own record. This journal should capture and detail each episode, including what happened before the episode hit and the potential triggers.

• Share your findings with your doctor. These records will help create a viable, preventative, treatment and management strategy.

Treatment and management

It can be challenging to treat a health condition of unknown origin, but progress is constantly being made.

As medicine improves, there are promising studies on remedying this condition. A neurology case report¹¹ indicates that toxin injections can alleviate the symptoms of abdominal migraines in adults.

After an accurate diagnosis, your doctor might prescribe any of the following medications: 

• Triptans – to halt symptoms before an episode hits

• Sumatriptan and zolmitriptan are the only FDA-approved triptans for six-year-olds and above in the US

• Naratriptan

• Rizatriptan

• Almotriptan

• Frovatriptan

• Eletriptan

• Anti-nausea medications – help alleviate nausea and vomiting. If these symptoms persist, your doctor can provide fluids via IV (hydration therapy)

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – reduce pain, inflammation, fever, and blood clots. Some FDA-approved NSAIDs include ibuprofen, naproxen, diclofenac, celecoxib, and aspirin

However, check with your doctor first before taking or giving your child any medications.

You can prevent certain triggers before the abdominal migraines hit, or in between episodes, by:

• Ensuring you or your child get enough sleep

• Managing stress through various activities such as exercising and yoga

• Cognitive behavior therapy (CBT)

• Gut-directed hypnotherapy to reduce digestive symptoms

Similarities between migraines and abdominal migraines

Although different in nature, abdominal migraine and migraine do share some similarities. The two conditions have common triggers, such as lack of enough sleep, stress, missing meals, exposure to bright or flickering light, weather changes, such as a change in barometric pressure, and consuming foods rich in caffeine, chocolate, and monosodium glutamate (MSG).

When to seek medical attention for an abdominal migraine

See a doctor if you notice any of the following symptoms:

• Recurrent and unexplained abdominal pain. A diagnosis can help your doctor rule out more serious causes for these recurring pains. It's crucial to determine if your stomach aches result from other underlying conditions.

• Blood in stools or vomit

• Excess diarrhea

• A high fever

• Sudden loss of appetite or weight loss

If you suspect that you or your child may have abdominal migraines for any reason, it's important to seek medical attention. Even if the symptoms aren't severe, talking to a doctor will help ensure that they don't get worse or lead to other health problems.

It's also worth consulting a doctor if you have a family history of stomach migraines or similar conditions such as irritable bowel syndrome. They may be able to recommend lifestyle changes or medications that can prevent or reduce migraines in the future.

The lowdown

It can be challenging living or dealing with a condition of unknown origin. In some cases, you might label the pain as a typical 'stomach flu' or 'stomach bug.' If the stomach pain persists or recurs, talk to your doctor/pediatrician, and they'll advise or refer you to a specialist.

When you visit the doctor, provide as many honest details of the episodes as possible. Also, provide any documentation, such as a diary, for a better reference. Stick to what the doctor advises you to do or a plan they create. Don't let this condition curtail you or your child from performing their daily activities.