Abdominal Migraine, Another Cause of Abdominal Pain in Adults
Am J Med. 2012 Aug 29;
Roberts JE, Deshazo RD
Abstract
BACKGROUND: Abdominal migraine is a diagnostically challenging childhood disorder, characterized by recurrent episodes of abdominal pain, which has not been clearly demonstrated to occur in adults.
METHODS: We used 2 sets of consensus criteria for the diagnosis of abdominal migraine in children to evaluate adults suspected of having this condition in both our own patient population and in the medical literature. Two patients in our clinic and 11 patients from the medical literature composed our initial study cohort and were analyzed using the International Classification of Headache Disorders, 2(nd) Edition and American College of Gastroenterology Rome III Diagnostic Criteria for abdominal migraine in children.
RESULTS: Ten of these patients met inclusion criteria for definite or probable abdominal migraine and comprised our final study cohort. The 10 patients from this adult cohort shared common demographic and clinical characteristics with children suffering from abdominal migraine, including a familial history of migraine in 90%.
CONCLUSIONS: Our findings demonstrate that abdominal migraine occurs and should be considered in the differential diagnosis of recurrent abdominal pain in adults, especially if there is a family history of migraine headaches.
PMID: 22939361
www.ihs-headache.org/upload/ct_clas/ihc_II_main_no_print.pdf
From the International Classification of Headache Disorders 2nd Edition:
Abdominal migraine
Description:
An idiopathic recurrent disorder seen mainly in children and characterised by episodic midline abdominal pain manifesting in attacks lasting 1–72 hours with normality between episodes. The pain is of moderate to severe intensity and associated with vasomotor symptoms, nausea and vomiting.Diagnostic criteria:
A. At least 5 attacks fulfilling criteria B–D
B. Attacks of abdominal pain lasting 1–72 hours (untreated or unsuccessfully treated)
C. Abdominal pain has all of the following characteristics:
1. midline location, periumbilical or poorly localised
2. dull or ‘just sore’ quality
3. moderate or severe intensity
D. During abdominal pain at least 2 of the following:
1. anorexia
2. nausea
3. vomiting
4. pallorE. Not attributed to another disorder
Note:
1. In particular, history and physical examination do not show signs of gastrointestinal or renal disease or such disease has been ruled out by appropriate investigations.Comments:
Pain is severe enough to interfere with normal daily activities. Children may find it difficult to distinguish anorexia from nausea. The pallor is often accompanied by dark shadows under the eyes. In a few patients flushing is the predominant vasomotor phenomenon.
Most children with abdominal migraine will develop migraine headache later in life.
Recognizing and diagnosing abdominal migraines
J Pediatr Health Care. 2010 Nov-Dec;24(6):372-7. Epub 2010 Feb 4.
Popovich DM, Schentrup DM, McAlhany AL.
Abstract
Abdominal migraine affects 1% to 4% of children and is a variant of migraine headaches. Onset is seen most often between the ages of 7 to 12 years, with girls affected more often than boys. Presenting symptoms include acute incapacitating non-colicky periumbilical abdominal pain that lasts for 1 or more hours. Pallor, anorexia, nausea, vomiting, photophobia, or headache may be associated with the episodes, and a family history of migraine headaches often is noted. The diagnostic process begins with a thorough history and physical examination and often follows a series of exclusions or elimination of other organic causes. Limited research exists regarding treatment options, but they may include pharmacologic intervention and prevention based on lifestyle modifications.
PMID: 20971412
PATHOPHYSIOLOGY
Several hypotheses have been investigated to deter- mine the pathogenesis and pathophysiology of abdominal migraine pain. Factors include IgE-mediated diet-induced allergy, gut mucosal immune responses, phenol sulfotransferase enzyme M and P catabolism of catecholamines and monoamines, and the perme- ability of the gut mucosal surface (Bentley et al., 1995). Weydert, Ball, and Davis (2003) discussed the relationship between the gut and the central nervous system (CNS). Derived from the same embryologic tissues, the enteric nervous system and CNS have direct effects on each other. These investigators proposed that stress increases CNS arousal, during which neuropeptides and neurotransmitters are released. This situation, in turn, leads to dysregulation of the gastrointestinal system. While the consistent symptom is episodic abdom- inal pain with clear-cut symptom-free intervals, the pathophysiology of pain is beyond the scope of this discussion.
PHARMACOLOGIC THERAPY
Abnormal concentrations of vasoactive amines, such as noradrenaline and serotonin, typically are found in adults who have migraine headaches. Anti-migraine drugs are intended to prevent the painful events by interfering with the biochemical pathways. There are no studies evaluating similar biochemical imbalances in children with AM; however, pharmacologic management in the treatment of migraine headaches has proved to be effective in treatment of AM (Tan, Sahami, Peebles, & Shaw, 2006).
Interesting migraine variant. But it is a diagnosis of exclusion. Other illnesses have to be ruled out first. Thus a good GI workup needs to be done. A gastroenterologist consult may be needed to do a procedural evaluation – e.g. to rule out ulcers, hiatal hernia, diverticulitis, ulcerative colitis, Crohn’s disease, Celiac Disease, etc. as part of the work-up.