Pediatric abdominal migraine: current perspectives on a lesser known entity

Abstract

BackgroundAbdominal migraine (AM) is a common cause of chronic and recurrent abdominal pain in children. It is characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. Despite the presence of comprehensive diagnostic criteria under Rome IV classification of functional gastrointestinal disorders (FGIDs) and International Classification of Headache Disorders, it continues to be an underdiagnosed entity.OverviewThe average age of diagnosis is 3–10 years with peak incidence at 7 years. Most of the patients have a personal or family history of migraine. Pathophysiology of the condition is believed to be similar to that of other FGIDs and cephalic migraine. It is also well recognized as a type of pediatric migraine variant. A careful history, thorough physical examination, and use of well-defined, symptom-based guidelines are needed to make a diagnosis. Selective or no testing is required to support a positive diagnosis. It resolves completely in most of the patients. However, these patients have a strong propensity to develop migraine later in life. Explanation and reassurance should be the first step once the diagnosis is made. Nonpharmacologic treatment options including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management. Drug therapy should be considered only if symptoms are refractory to these primary interventions.ConclusionMore research focused on pathophysiology and management of AM needs to be carried out to improve outcomes in affected children.

The Effects of the Rome IV Criteria on Pediatric Gastrointestinal Practice

“…The committee believes that abdominal migraine, cyclic vomiting, and migraine headache share the same pathophysiology, but none of the current hypotheses have been definitely confirmed [37]. There is a need for studies to better characterize this family of disorders, the common triggers, natural history, and treatment options.…”

“…This more specific diagnosis of patients with abdominal migraine has important implications for treatment, as management strategies between abdominal migraine and IBS differ. Primary interventions for abdominal migraine include preventive measures such as avoidance of triggers, behavior therapy, and dietary modifications [37]. Pharmacological treatment should be considered if symptoms are refractory to these interventions [37].…”

“…Primary interventions for abdominal migraine include preventive measures such as avoidance of triggers, behavior therapy, and dietary modifications [37]. Pharmacological treatment should be considered if symptoms are refractory to these interventions [37]. Up until now, only one small (n = 16) double blind placebo controlled study has evaluated the effect of pizotifen (not available in the USA) as a prophylactic treatment, which showed a positive effect [38].…”

Fifty‐eight‐year‐old female with abdominal migraine: A rare cause of episodic gastrointestinal disturbance in adults

“…This condition is often worked up and treated for irritable bowel syndrome, functional dyspepsia, and food allergies. Children with AMs usually grow out of the condition but some may grow up to experience migraine headaches and recurrent abdominal pain as adults 3 . The diagnostic criteria for AM have been established in children, 4,5 and our review of the literature shows evidence of AM being diagnosed in adults 6‐17 .…”

“…Abdominal migraine is poorly understood and few different hypotheses exist to explain its pathophysiology. A visceral hyperalgia hypothesis suggests early indistinct environmental stressors to the enteric nervous system can cause altered release of gut hormones such as serotonin impairing intestinal secretions and motility 3 . AM patients also tend to have slower gastric emptying rates, increased gut permeability, abnormal gut motility, and enteric electrolyte imbalances which together may underlie symptomatology 20,21 .…”