What is abdominal migraine?

Abdominal migraine is a form of migraine that causes episodes of moderate to severe abdominal (belly) pain. The episodes last from one to 72 hours. On average, they last 17 hours. The pain can be severe enough to interfere with daily activities.

It doesn’t cause head pain, but a person can experience a traditional migraine headache and an abdominal migraine at the same time.

Researchers believe there’s a connection between migraine headache and abdominal migraine. The conditions seem to have similar triggers, relieving factors and treatments. They may have a similar cause as well. About 24% of people who have abdominal migraine have migraine headache at some point in their lives, compared to 10% of the general U.S. population.

Who do abdominal migraines affect?

Abdominal migraines most commonly affect children under 10 years old, but they can also affect adults.

The average age of onset is 7 years. It’s more common in women than in men.

What are the risk factors for abdominal migraines?

Having a family history of migraine headaches increases your child’s risk of developing abdominal migraine. Over 65% of children who experience abdominal migraines have a first-degree relative (biological parent or sibling) with migraine headaches.

Psychosocial factors such as anxiety and depression can also increase the risk of developing both abdominal migraines and migraine headaches in children.

How common is abdominal migraine?

Approximately 1% to 4% of school-aged children have abdominal migraine. Researchers think this estimate might be low, as the condition may be underdiagnosed.

Abdominal migraine is rare in adults.

What are the symptoms of abdominal migraine?

The main symptom of an abdominal migraine episode is abdominal (belly) pain. The pain is usually in the middle of your belly around your belly button. It may feel like a dull ache or soreness and can be moderate or severe.

The episodes usually start suddenly and end abruptly. They can last between one and 72 hours.

Other symptoms that you or your child may experience during an episode include:

• A pale appearance (pallor).
• Loss of appetite.
• Nausea.
• Vomiting.
• Headache.

Some people may experience other migraine symptoms, like light sensitivity (photophobia) and noise sensitivity (phonophobia).

The time between episodes can range from weeks to months. People typically don’t have symptoms in between episodes.

What causes abdominal migraines?

Researchers don’t know yet what causes abdominal migraines, but they have a few hypotheses.

The main hypothesis is that people who experience abdominal migraine have overly sensitive nervous systems — specifically the primary sensory and central spinal neurons in this system. Researchers think that certain genetic, psychosocial and environmental factors may make someone vulnerable to this hypersensitivity.

When a person experiences certain triggers (such as motion sickness or stress), their body abnormally releases neurotransmitters (chemical messengers). One neurotransmitter in particular, serotonin, may contribute to abdominal pain.

What triggers abdominal migraines?

Certain situations may trigger episodes of abdominal migraine. These can vary from person to person.

Common triggers include:

• Stress, such as from school or family life.
• Poor sleep and irregular sleep habits.
• Prolonged fasting.
• Dehydration.
• Travel and motion sickness.
• Exercise.
• High-amine foods, such as citrus fruits, chocolate, cheese, salami and ham.
• Foods with additive flavoring, coloring and monosodium glutamate (MSG).
• Flashing lights.
• Consuming over 200 milligrams of caffeine.

How is abdominal migraine diagnosed?

Abdominal migraine can be difficult to diagnose, as several conditions and situations can cause abdominal pain.

In addition, children may have difficulty describing their pain and expressing the difference between these symptoms and a typical stomachache.

There aren’t any lab or imaging tests that can diagnose abdominal migraine. Instead, healthcare providers rely on a thorough understanding of your child’s symptoms and medical history to make a diagnosis.

Providers also need to rule out other health conditions that cause similar symptoms, including:

• Cyclic vomiting syndrome.
• Stomach ulcers.
• Crohn’s disease.
• Irritable bowel syndrome (IBS).
• Bladder or kidney conditions.

Your child’s provider will:

• Review their medical history and your family’s medical history.
• Do a physical examination.
• Order tests, such as an abdominal ultrasound or X-ray, to rule out other conditions.

How is abdominal migraine treated?

There’s no cure for abdominal migraine. Instead, treatment mainly focuses on preventing episodes. There are also ways to treat episodes of abdominal migraine once they begin.

Strategies to prevent abdominal migraines

Preventing abdominal migraine episodes involves understanding your child’s triggers. Keeping a journal for tracking symptoms can help narrow down possible triggers.

In general, preventative measures include:

• Managing stress: Practicing healthy coping skills can help manage stress. A type of psychotherapy (talk therapy) called cognitive behavioral therapy (CBT) can also help with stress management.
• Travel tips: It’s important to avoid motion sickness when traveling. This could include limiting long vehicle trips with frequent stops and avoiding high altitudes.
• Getting quality sleep: Getting quality sleep is essential for people with abdominal migraine. Having a regular bedtime routine and good sleep hygiene can help prevent sleep disturbances, which can trigger episodes.
• Avoiding visual triggers: Sparkling and flashing lights can trigger episodes, so avoid them as much as possible.
• Avoiding food triggers: Try to identify any foods that seem to trigger episodes and remove them from your/your child’s diet. Also, try to avoid eating foods containing MSG and additive flavorings and colorings.

Medications to prevent episodes

The U.S. Food and Drug Administration (FDA) hasn’t yet approved any medications for the treatment of abdominal migraine. However, some healthcare providers may prescribe certain medications off-label. Many medications that help prevent migraine headaches can also help prevent abdominal migraines.

Studies have shown that the following medications may help prevent abdominal migraine episodes:

• Cyproheptadine.
• Pizotifen.
• Propranolol.
• Flunarizine.

Treatment for abdominal migraine episodes

If your child is experiencing an abdominal migraine episode, resting in a dark and quiet place with a cool cloth or ice pack may help resolve their symptoms.

Your child’s healthcare provider may also recommend or prescribe any of the following medications to help treat episodes:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen or aspirin.
• Antinausea medications.
• Triptans (serotonin receptor agonists).

What is the prognosis of abdominal migraine?

Children with abdominal migraine usually start to outgrow the condition around puberty. Approximately 60% of children no longer have episodes by their late teenage years.

However, about 70% of children with abdominal migraine will develop migraine headaches later in life — either in their adolescent or adult years.

How can I help my child with abdominal migraine?

Abdominal migraine can be distressing and affect your child’s social and academic life. Because of this, it’s important to believe your child and advocate for their health.

Talk with your child’s healthcare provider about their symptoms, share any family history, especially a history of migraine, and bring up abdominal migraine as a possible cause of their symptoms.

It can take some time, but try to keep notes on possible triggers of episodes and eliminate them, if possible, to prevent future attacks.

When should my child see a healthcare provider if they have abdominal migraine?

If your child has vomited several times from an abdominal migraine episode, call their healthcare provider. They may need to be admitted to a hospital for treatment that will control the vomiting and prevent or treat dehydration.