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What is an abdominal migraine?
Abdominal migraine causes repeated bouts of stomach pain. It mostly occurs in children. Kids with abdominal migraine often have other symptoms, such as headache, nausea, and vomiting.
Abdominal migraine attacks, also known as gastric headaches or stomach migraines, are very painful and can interfere with a child’s daily activities, including school.
The symptoms can usually be treated with over-the-counter medications. Children who have abdominal migraine have a greater risk of developing migraine headaches as adults.
Abdominal migraine in adults
Abdominal migraine occurs most often in children and is rare in adults. But if you experience chronic, recurrent abdominal pain and your doctor has ruled out other conditions, abdominal migraine could be the cause. Also, having a family history of migraines or getting migraine headaches may mean you’re having abdominal migraine. Adults with abdominal migraine are treated the same as children.
Most common symptoms
Abdominal migraine causes repeated episodes of abdominal pain along with headache, nausea, and vomiting.
Because it can start at such a young age, a stomach migraine may be tricky to diagnose at first. Older children are often better at describing their symptoms. In younger children, look for nonverbal cues like holding their belly or crying without another reason. —Dr. Karen Hoerst
- Abdominal migraine is most common in children ages 3 to 10. The average age that it starts is 7 years old.
- Children with family members who get migraines have a greater risk.
- Some studies show that young girls have a higher risk of abdominal migraine, compared to boys, but both boys and girls can get them.
There is no clear-cut cause for abdominal migraine. But they may occur for these reasons:
- Some studies show that people with abdominal migraine have abnormal gut motility. This means that it takes longer for food to digest and pass through the gastrointestinal (GI) tract, making the stomach full and bloated. One theory is that this can cause abnormal contractions and lead to pain.
- Abdominal migraine may happen when pain-sensitive tissues and organs in the abdomen, such as blood vessels and muscles, aren’t regulated well. Children with abdominal migraine may have an inappropriate pain response to triggers like stress, dehydration, and fatigue.
While each person can have their own food triggers for stomach migraines, some of the most commonly reported ones include cheese, chocolate, MSG (monosodium glutamate), and preserved meats containing nitrites, like lunch meats or hot dogs. —Dr. Hoerst
Abdominal migraine triggers
Like other types of migraine, abdominal migraine often has specific triggers. Many children have a set pattern of symptoms and can tell when an abdominal migraine is coming on. Common triggers include:
- Stress from school, family, sports, and other activities
- Not eating or drinking enough, such as during another illness. Dehydration can trigger a migraine.
- Poor sleep or sleeping less than 8 to 9 hours a night
- Certain foods and drinks, particularly cheese, chocolate, carbonated drinks, caffeine, and citrus. Some children are very sensitive to foods with artificial colorings or flavorings.
- Bright lights, sensitivity to light. Your child may want to lay down in a dark or shaded room during a migraine.
How abdominal migraine is diagnosed
Abdominal pain, headaches, nausea, and vomiting can be signs of other conditions, so your doctor has to rule out other problems to diagnose abdominal migraine. Your doctor will do a physical exam and may order blood tests and imaging tests. Conditions they’ll be checking for include inflammatory bowel disease, celiac disease, and infections.
The criteria for diagnosing abdominal migraine from The International Classification of Headache Disorders are:
- Moderate to severe, chronic, and recurring abdominal pain
- Bouts that last more than one hour
- Having at least two of the following symptoms: nausea, vomiting, headache, paleness, poor appetite, or photophobia (sensitivity to light)
- Pain severe enough to interfere with normal activities
- Bouts separated by weeks or months. In between, your child does not get symptoms.
- Having at least two episodes in a 6-month period
Keeping track of when the symptoms happened, how long they lasted, if there were any other symptoms present (such as headache) or if any triggers, such as stress or food, were present can be so helpful in establishing a pattern and making a diagnosis. —Dr. Hoerst
Lifestyle changes are the best way to treat abdominal migraine. These include avoiding triggers and learning coping skills.
Behavioral therapy is very important for learning how to cope with symptoms. One of the goals of therapy is to get your child back into normal activities (school, activities, etc.) in spite of their discomfort. Returning to activities also reinforces that children can manage their symptoms on their own.
Medications are not regularly used to treat abdominal migraines unless they are frequent. In these cases, OTC medications like acetaminophen or ibuprofen might be recommended. Sometimes preventative medications are needed to reduce the number of abdominal migraines.
Certain supplements can also help relieve symptoms.
- Probiotics may relieve abdominal migraine and GI symptoms by helping to restore the gut microbiome. The gut microbiome consists of thousands of tiny organisms that normally live in the digestive tract and regulate GI health.
- Fiber-rich foods (beans, broccoli, whole grains, dried fruits, etc.) or fiber supplements can help some children with bloating or gastric motility problems.
If your child has stomach pain along with a sudden, severe headache for the first time, call 911. The headache could be a sign of a life-threatening condition like meningitis or stroke.
If your child already has abdominal migraines, the most helpful thing to do may be to lie down in a dark room and rest. Be sure to follow up with your doctor to create an effective treatment plan.
Since abdominal migraines often have triggers, you can help prevent them with these lifestyle changes:
- Reduce stress. This isn’t easy, especially with a child. But introducing kids to activities like yoga, deep breathing, or meditation can give them tools to deal with life stressors in healthy ways. Also, consider situations in the home or at school that may be causing them stress, and work to reduce them.
- Eat a healthy, balanced diet.
- Get enough sleep. Fatigue can trigger migraines.
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.