Abdominal Migraine (AM) is a condition – a variant of migraine – that might sound unfamiliar; it is relatively uncommon, but it is essential for parents and caregivers to understand, particularly if there is a history of migraine in the family.
Abdominal Migraine (AM) is often called the ‘child’s migraine’ because it occurs predominately in children. It is relatively rare in adults. Surveys indicate that the prevalence in children varies from 0.2% to 9%, typically between 3-10 years, with a peak incidence around seven years. It is more prevalent in girls than boys, approximately 2:1.
What is it?
Diagnosing AM can be difficult. Children have difficulty distinguishing the features of an AM from an ordinary upset stomach, stomach flu or other gastrointestinal illnesses.
The first step is to eliminate other causes of stomach pain.
Authorities suggest that a family history of Migraine and AM is a key factor in determining the possibility of AM.
AM is episodes of moderate to severe belly pain, usually around the belly button area. These episodes vary from 60 minutes to 72 hours, typically around 17 hours.
Other symptoms may include nausea and possibly vomiting, although vomiting is less than in another migraine variant ‘, cyclic vomiting syndrome’. Other features include loss of appetite and pallor – they might look pale or ‘washed out’.
Photophobia (sensitivity to light) and phonophobia (sensitivity to sound) may also be present and perhaps differentiate recurring tummy pain from a virus or
Because it is classified as a migraine, headache is expected to be present, but it is typically absent in AM.
The prognosis?
Approximately 60% of children grow out of it by their late teens.
Comment: However, whilst I cannot provide exact numbers, my experience is that in some children over 2-3 years in their early teens, their AM transforms to be experienced in their head, i.e., head pain.
Other surveys indicate around 70% will on and develop migraine or recurrent abdominal pain.
What causes it?
Answer: Unknown
There are various theories, but because AM is a migraine variant, they are based on what is purported to be the cause of migraine, and this remains speculative. While the exact mechanisms are still being researched, sensitisation of the brainstem is widely agreed to be the underlying disorder in migraine. It is, therefore, likely to play an essential role in AM.
Accordingly, AM is thought to be underpinned by a neurological issue – sensitisation (or ‘overactivity’) of the brainstem. The brainstem significantly influences various aspects of abdominal function and is the meeting place of many nerves, including the vagus nerve, which runs from the gut to the brainstem. If the brainstem is sensitised, normal messages from the gut are exaggerated or amplified, leading to abdominal pain, nausea and vomiting.
Treatment
Because AM is a migraine variant and often leads to migraine as an adult, treatment is modeled on migraine treatment, i.e. primarily pharmaceutical.
These include antidepressants for serotonin, a biochemical thought to be involved in migraine but not proven (antidepressants increase serotonin). Other medications may include anti-inflammatories to control pain and medication to help manage nausea and vomiting. Furthermore, triptan medication, developed specifically to abort migraine, is also prescribed. Importantly, triptan medication aborts migraine by desensitising the brainstem.
Comment: Are antidepressants or heavy-duty migraine medication appropriate for a child? Especially when the pharmaceutical approach deals with symptoms, not the cause.
Other approaches are identifying and avoiding triggers and lifestyle modifications, such as regular sleep, meals, hydration, and exercise. While stress is considered by some to be involved, psychological counseling is sometimes recommended.
Comment: Good Luck! Triggers are not a cause. Furthermore, they are often difficult to recognise and, therefore, avoid. Implementing the other strategies in a six-year-old is, perhaps, difficult.
Evidence supports that (painless) musculoskeletal misbehaviour in the upper neck can sensitise the brainstem in migraine and that my research has shown that manual (not ‘cracking’ of the joints) therapy can desensitise the brainstem.
The Watson Headache® Approach, a specific manual therapy protocol, has been shown to decrease the brainstem’s sensitivity.
Conclusion
While AM is harmless, it can significantly impact the quality of a child’s (a critical phase of) life and whole families. This needs to be managed appropriately. All possibilities must be considered, and the current medical recommendations, i.e. tolerating medication and its effects on a child’s body, identifying triggers, modifying lifestyle, etc., must be approached empathetically and realistically.
Assessing and treating the upper neck in those with AM over the past 30 years has changed my perspective: AM is one of the most rewarding conditions I treat.
