Talking To Your Childs Doctor About Abdominal Migraine
If your child is experiencing symptoms that you feel may be abdominal headaches, the more you can tell their doctor, the better. Show them the migraine diary that you have been keeping for your child and tell them about any symptoms that really concern you.
Abdominal migraine is an unusual condition and many doctors are not well acquainted with the symptoms, diagnostic criteria, or treatment. Amigraine specialist may be a better option for diagnosing and treating your child. These doctors specialize in migraines and may be better equipped to provide a diagnosis. They can then work with you to create a treatment plan for your child that will help prevent attacks and relieve symptoms in the event an attack occurs.
However, talking to a specialist or your childs pediatrician can be a daunting task. Having an open, honest conversation and sharing as much information as possible give the doctor insight into certain lifestyle triggers and any familial traits that can be causing the attacks. Often, though, the diagnosis starts at home. It begins with parents observing their childs behavior and noting their illness. From there it leads to the doctors office and testing. Still, the parents are the key. Dr. Caminez offers some signs parents can look for.
Symptoms Of Abdominal Migraine
Abdominal migraine consists of episodes of abdominal pain that may be accompanied by nausea, vomiting, loss of appetite or loss of facial color. The abdominal pain is generally located in the middle of the abdomen. Patients often describe it as dull or sore, but it can become moderate and even severe. Between episodes, there should be no symptoms. According to Dr. VanderPluym, Attacks last between 2-72 hours. Notably, abdominal migraine doesnt impair a childs growth or development.
Treatment Options For Abdominal Migraine
When diagnosing abdominal migraine, it is important that the doctor takes the medical history and physically examines the patient to rule out or to diagnose other diseases.
Treatment is often similar to that for other types of migraine, but options are more limited for children.
You should try to identify if the abdominal migraine attacks have a common trigger, such as bright light, poor sleep, travel or hunger. Stress and dealing with difficult emotions may be triggers for children too. Avoiding or limiting these triggers can help with reducing the number of attacks.
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Abdominal Migraines In Children
Abdominal migraine is prevalent in children ages five to nine years old and rarely occurs in adults. The prevalence among children is 4 percent while the mean age of onset is 7 years old. Abdominal migraine resolves in about 66 percent of patients by their late teens and 50 to 70 percent will go on to develop migraine attacks associated with head pain that is a well known and prominent feature of migraine, said Dr. VanderPluym. Migraine is a polygenetic disease and, similarly, the incidence of abdominal migraine is linked to other family members with migraine.
Resources For Abdominal Migraine Patients And Their Families
Although abdominal migraines are rare, there are several very good resources for patients and their families. Facebook has two very good groups and some parenting and health forums have good threads that discuss the condition.
Sometimes it helps just to know that you are not alone in a situation. Sometimes it helps to hear from someone who has been where you are, who has gone through what you are experiencing. Look for support groups in your area as well as online. You dont have to go through it alone and you shouldnt have to.
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What Is Abdominal Migraine
Abdominal Migraine is a pathological condition which has nothing to do with the migraines that one usually speaks about which is characterized by severe headaches. In fact, in Abdominal Migraine there are no headaches involved at all. Instead, it is the abdominal area which is affected and the individual suffers from severe abdominal or stomach pain. Abdominal Migraine is mostly seen in children but in some cases they have occurred in adults as well.
The pain caused by Abdominal Migraine is severe and incapacitating and tend to have the same triggers as that of migraine headaches. Apart from severe abdominal pain, it tends to also cause nausea, vomiting, and at times even cramping sensation.
Children with a family history of migraines are more likely to get Abdominal Migraine than the normal population and girls are more prone to Abdominal Migraine than boys. It is also seen that migraine headaches develop later in life in those children who have a history of Abdominal Migraines.
Chronic Recurrent Abdominal Pain
Children and adolescents with chronic abdominal pain are challenging both for their caregivers and their pediatricians. The daily lives and activities of affected children and their families are interrupted by the distressing symptoms. For the past 40 years, the definition of chronic abdominal pain denotes at least three pain episodes over at least 3 months interfering with function.1 In clinical practice, it is generally believed that pain exceeding 1 or 2 months in duration can be considered chronic.13,14
Previously, chronic abdominal pain in children was referred to as recurrent abdominal pain and classified as either organic RAP, which applied to 5% to 10% of children,15-18 or functional abdominal pain, which affected 90% to 95% of children with chronic abdominal pain.19,20
In March 2005, the American Academy of Pediatrics and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition issued a policy statement recommending that the term recurrent abdominal pain no longer be used: Functional abdominal pain is the most common cause of chronic abdominal pain. It is a specific diagnosis that needs to be distinguished from anatomic, infectious, inflammatory, or metabolic causes of abdominal pain.13,14 Functional abdominal pain should be categorized as one or a combination of functional dyspepsia, irritable bowel syndrome , abdominal migraine, or functional abdominal pain syndrome.
Functional abdominal pain
How Else Can Migraine Be Treated
Some over-the-counter headache medications can help with the pain, such as Tylenol or Excedrin . If your migraine attacks are more severe or frequent, your doctor may prescribe medications or other treatments for you.
For relief without pills, your doctor may suggest trying Botox injections or using a neuromodulation device like the Cefaly Dual.
Resting in a dark, quiet room helps some people. For extra help, a cold compress on the head can have a numbing effect. There are also natural remedies you can try, including supplements like:
What Are The Common Symptoms To Look Out For
Episodes of abdominal pain lasting more than an hour on a recurring basis in children with accompanying features which are typical of migraine like light sensitivity, nausea, sensitivity to movement, may be abdominal migraine. The child is completely well in between attacks. Also bouts of abdominal pain may also be accompanied by vomiting. This condition is relatively common but often not diagnosed because of the absence of headache at the time.
Abdominal migraine can lead to frequent school absences, inappropriate and sometimes intrusive investigations and even unnecessary surgery.;As many as 4-5% of children with abdominal migraine have been found to have had unnecessary operations in one study.;Hence an early diagnosis is important.
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Diagnosis Of Abdominal Migraine
A diagnosis of abdominal migraine is what Dr. Elton calls a diagnosis of exclusion. Meaning, you cant definitively diagnose someone with it because there are no tests to confirm it exists. But, you can rule out other conditions that cause similar symptoms and, ultimately, end up at an abdominal migraine diagnosis if everything else seems in order.;
The provider can start with a comprehensive medical history and physical examination; it is particularly important they ask about family history of migraine or headaches. Many times, you do not need a specialist to diagnose abdominal migraine. If the provider performs a physical examination for your child, runs blood panels or other diagnostic tests, and cant find any sign of GI disease, irritable bowel syndrome , ulcers or obstructions, reflux, or gallbladder issues, thats a good sign that the problem may not be with the gut but with the brain. At that point, your child may be referred to a neurologist.
But dont jump the gun: Dr. Elton says a primary care provider or pediatrician is the best first step to take before seeing a specialist. They can rule out acute viral infection, ask you about your family history of migraine or GI illness, and decide where to refer you next, if need be.;
It can be tricky to diagnose abdominal migraine, but the diagnostic criteria includes the following:;
- The child has at least five attacks of abdominal pain, and include:
- Pain has at least two of the following three characteristics:
Migraine Evolution And Progression
Cyclical vomiting, abdominal migraine, and paroxysmal vertigo represent precursors of adulthood migraine according to IHS criteria, and their presentation supports the notion that migraine is present early in life, albeit with different manifestations than in adults. These manifestations represent non-specific and low-grade paroxysmal events, perhaps as a reflection of an immature brain . There is reportedly evidence that the above-noted precursors of adult migraine are neurobiologically related to migraine , and therefore the diagnosis of migraine should be considered in young children with these manifestations. Interestingly, the diagnosis in adolescents may not be as recognizable as in adults . In a 3-year follow-up, a large proportion convert to probable migraine without aura in the revised IHS criteria .
Migraine attacks tend to disappear following severe traumatic brain injury and to recur after cognitive functioning significantly improves . Therefore, the more severe the brain damage, the later the recovery of a fully developed migraine attack. Neurodegenerative diseases presenting with focal brain damage in dopaminergic areas, such as substantia nigra, may shorten the lifetime clinical course of migraine .
Tommy Y. Kim MD, Tonya M. Thompson MD, in, 2008
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What Is An Abdominal Migraine
The International Headache Society defines an abdominal migraine as an idiopathic disorder seen mainly in children as recurrent attacks of moderate to severe midline abdominal pain, associated with vasomotor symptoms , nausea and vomiting, lasting 2-72 hours and with normality between episodes. A headache does not occur during these episodes.
An abdominal migraine occurs mostly in infants, toddlers, children, and teens. Most children with abdominal migraines will develop a migraine headache later in life.
An abdominal migraine is rare, but not unknown, in adults. Other disorders are ruled out first, such as irritable bowel syndrome, lactose intolerance or reflux before an adult is diagnosed with an abdominal migraine, which can take several years.
According to a review done on abdominal migraine,
- Abdominal migraines are usually diagnosed at the age of 3-10 years.
- Early studies by Cullen and MacDonald found that childhood abdominal migraine typically evolved into migraine headaches in adulthood.
- Several studies have linked abdominal migraine to migraine headache in later life and a family history of migraines.
- Children with recurrent abdominal migraine are at risk of impairment of their social and educational development, which places a significant burden on communitys healthcare resources.
What Treatments Are Available For Abdominal Migraines
Children receive treatments based on their symptoms, and the causes and triggers for their abdominal migraines.
Once your care team determines the stress, event or food that triggers the abdominal migraine, they will work to remove that source of stress and reduce your child’s pain. Your doctor might suggest medications to relieve pain or medications used to treat migraines. It is important to know that some medicines may not work for your child, so talk to your doctor about options.
“Remember that the medicines stop an attack, but they do not prevent one,”;says Dr. Sanghavi. To prevent an abdominal migraine, work with your child to monitor and reduce stress and avoid eating trigger foods.
Other treatments include:
- Cognitive behavioral therapy
- Guided imagery
“Stress cannot always be controlled, but we can teach a child how to control their body’s response to stress,”;says Dr. Sanghavi. “We recognize that some children need help relaxing.”
Children likely outgrow abdominal migraines, but may develop migraine headaches during adolescence or adulthood. “Managing migraines is not a sprint, but a marathon,”;says Dr. Sanghavi. “We help families make lifestyle changes now that will last for life.”
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Signs And Symptoms Of Abdominal Migraine
The symptoms of abdominal migraines are distinctive; the most prevalent beingmidline abdominal pain. This means that the pain is in the middle of the abdomen, around the belly button. The pain does not extend to the sides.
Axon Optics published theGuide to Types of Headaches in 2016. In it, abdominal migraines are characterized as:
A migraine that does not affect the head, but rather the abdomen and can last from a few hours up to 72 hours. During attacks at least two of the following are symptoms: anorexia, nausea, vomiting, paleness. This is mostly commonly found in children and symptoms do not remain between attacks. Many children who suffer from abdominal migraine have migraine later in life.
The symptoms are what define this unusual condition and also include:
- Severe abdominal pain or intense soreness in the stomach
- Pain that causes
The onset of the attack is usually sudden and the symptoms or attack itself usually very severe. An abdominal migraine can occur with no aura or warning at all. An attack can last anywhere from 1 hour to 72 hours, but usually it lasts 4 or more hours. Patients do not experience any symptoms between their attacks.
The pain of the attacks is intense. Abdominal migraines predominantly occur in children and the symptoms may render the child non-functional. They may scream and cry in pain to the point that their parents take them to the emergency room.
What Parents Need To Know About Abdominal Migraine
One of the biggest concerns of parents who have children with abdominal migraines is the severe pain that the condition inflicts during an attack. Sometimes they are hesitant to take the child to the doctor, thinking that it is a stomach flu or just a little stomach bug. However, if your child is experiencing severe abdominal pain, especially if it happens more than once, they should see a doctor to rule out other, more serious problems.
Many parents are often concerned that even though the pain comes and goes, during an attack it is so severe that is often interferes with the childs daily activities which includes school. Several abdominal migraine episodes during one school year could result in the child missing a lot of school.
For parents who suspect their children may have abdominal migraines, Dr. Caminez has this advice, I recommend they always start with the childs pediatrician who can then be a referral source to a headache specialist. I find that abdominal migraines, like migraines in adults can be very confusing to diagnose. He continues, I have seen children as well as adults with migraines dismissed by doctors who just feel the condition is in their head. I always remind parents and patients that their doctor is there to give their expert opinion and treatment but if the parent is not satisfied with the care, it is never a bad idea to get a second opinion.
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How Is An Abdominal Migraine Diagnosed
Even though abdominal migraine is more common in children, it is still a rare condition. It is important to see a pediatric gastroenterologist who can rule out other causes of abdominal pain first, such as:
Because a diagnostic test is not available to diagnose abdominal migraine, Dr. Sanghavi explains that doctors oftentimes make a diagnosis of exclusion, ruling out other conditions to arrive at a diagnosis.
Association With Other Fapds
AM belongs to the class of FAPDs under Rome IV classification of FGIDs. The other disorders included are functional dyspepsia, IBS, CVS, and functional abdominal pain not otherwise specified. Many of the mechanisms postulated under pathogenesis of AM, especially the visceral hyperalgesia theory, have been studied mostly in patients with FGIDs . Helgeland et al noted that symptoms of IBS and AM overlapped in 33% patients as per the Rome III criteria. Clinical association between AM and other FGIDs needs to be evaluated further in research studies as it may open new avenues in the treatment of AM.
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Treatment For Abdominal Migraines
Your childs doctor might prescribe anti-migraine medications that your child can use daily to prevent future attacks or at the time to relieve discomfort during an attack. Cognitive behavioral therapy can also be helpful when managing chronic pain or reducing stress that could trigger a migraine episode. Occasionally your childs doctor might recommend complementary therapies such as acupuncture.
Once your childs abdominal migraines are under control, you will no longer need to see a GI specialist.
Causes And Risk Factors
Unfortunately, experts dont know the exact cause of abdominal migraine, but physicians have identified a few commonalities that may explain why some kids have it and others dont.
In general, the triggers for abdominal migraine are the same as they are for traditional migraine: stress, anxiety, travel , lack of sleep or proper nutrition and hydration, and illness can all trigger an attack. Of course, age is usually a factor with this condition since it most often strikes in childhood; if your child fits the profile and is between 3 and 10, its more likely to be a possible cause of their symptoms.
Oddly enough for a condition that causes stomach pain, food isnt typically considered a trigger. Dr. Friedman says dietary changes often dont help much with preventing episodes, and Dr. Elton agrees, saying that parents of young kids may want to take a conservative approach to searching for possible food triggers.
There are exhaustive food lists online , but if you eliminated all those foods, there would be nothing left for your child to eat, she warns, recommending that if you think something your child eats on a regular basis could be triggering attacks, try eliminating things slowly and one at a time rather than making sweeping changes.
As far as risk factors, theres mainly only one: genetics. There is a significant hereditary component in migraine, says Dr. Elton. We often find a positive family history of migraine in other family members, in a childs siblings.
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