The tummy monster
Abdominal migraine is a type of migraine most often seen in children. It does not involve headache symptoms. Instead, the pain is located in the belly. Small children will complain of “tummy aches”, refuse food or drink, and usually vomit before the attack is over. Other associated symptoms such as hypersensitivity to sensory stimuli, nausea, and vomiting are common.
The attacks last at least 2 hours and can be as long as 72 hours. As with other forms of Migraine, this one is a diagnosis of exclusion. In the absence of kidney, liver, gallbladder, or gastrointestinal disease, Abdominal Migraine is considered. This is especially true if one more family member has already been diagnosed with migraine. A diagnosis is confirmed when 5 or more attacks occur, absent headache, with 2 or more associated symptoms (anorexia, nausea, vomiting, or pallor). If a headache is present, then the more accurate diagnosis is Migraine without Aura.
The pain of Abdominal Migraine is in the middle of the abdomen, usually around the belly button, but may be diffuse. The pain quality is dull, rather than the characteristic throbbing of an acute headache phase. It can feel just as intense as the headache phase of a Migraine attack. Nausea and vomiting are common. In fact, recurrent complaints of belly pain followed by vomiting are often the first clues that your child is experiencing Abdominal Migraine. Lack of appetite (anorexia) is also possible. The skin may appear pale (pallor) and feel cold and clammy to the touch. There may be dark shadows under the eyes. Occasionally, a child will experience flushing of the skin instead.
Kids often complain of vague belly pain, so it is important to note that the symptoms of Abdominal Migraine are severe enough to interfere with even play time. A child who is experiencing an Abdominal Migraine attack will be very sick, unwilling or unable to eat, may cry or whine, and frequently vomits. Most of the time Abdominal Migraine is a predictive of developing Migraine with Aura or Migraine without Aura later in life.
The treatment for Abdominal Migraine is very similar to the treatment of other Migraine disorders and depends greatly on the age of the child. Anti-nausea medications are used in addition to NSAIDs or triptans. If the attacks are frequent, preventives may be indicated, too.
My family’s experience with the Tummy Monster
My oldest child started having symptoms of Abdominal Migraine just after her second birthday. Whenever she was exposed to bright lights, loud noises, strong smells, irregular bedtimes, or irregular mealtimes an attack would hit. She would become irritable, whining at everything, refusing food and drink. Within an hour, all the color would drain from her face and she would get very cold. With her tiny arms wrapped around her tummy, she would curl up in my arms for comfort. Then just before she dozed off to sleep from exhaustion, the projectile vomiting would start. For hours afterward she lay limp in my arms staring blankly from swollen eyes highlighted in dark circles -- symptoms we now recognize as a "migraine hangover."
I didn’t know about Abdominal Migraine back then, but suspected that somehow Migraine was to blame. She would have these episodes a few times every month. Then when she was four years old, she started complaining of head pain in addition to the other symptoms. Her symptoms had transformed into Migraine without Aura. Our local general practitioners and pediatricians were reluctant to diagnose headache disorders in children younger than five years old. Not a single doctor we consulted had any knowledge that Abdominal Migraine was even possible. It took a lot of “Momma Bear Advocacy” to get a referral to a pediatric neurologist. Thankfully, we found a good one who recognized the symptoms, made an accurate diagnosis, and prescribed Periactin syrup as a preventive.
If you have a child who is exhibiting these symptoms, don’t hesitate to fight for excellent care. Small children can and do get headache disorders. As with adult migraineurs, children are best diagnosed and treated by a headache specialist. The Migraine Research Foundation has a list of pediatric headache specialists. They deserve competent, compassionate care just like the rest of us. Early intervention increases the odds of good migraine control for a lifetime.
p.s. Grown-ups can get Abdominal Migraines, too!
Can you tell when a migraine attack is coming?