• Controversy exists between migraine versus epileptic pathogenesis. Although non-specific EEG changes are seen more commonly among these children, very few go on to develop signs of epilepsy.
• Children with abdominal migraine are more likely than controls to go on to develop more typical migraine headaches later in life; 10% of children with migraine headaches are found in retrospect to have suffered from unexplained abdominal pain prior to the onset of headache.
• Adult migraine headache sufferers experience abdominal pain more frequently than tension headache sufferers.
• May involve neuronal activity originating in the hypothalamus with involvement of the cortex and autonomic nervous system. Serotonin is implicated, and blockade of serotonin receptors has been shown to act prophylactically in abdominal migraine.
• May involve some, as yet ill-defined, local intestinal vasomotor factors.

• Mostly occurs in children between the ages of 3 and 10, peaking at about age 9.
• More common in girls.
• May affect as many as 1% to 2% of children at some point in their lives.
• Declining frequency toward adulthood.

• Giardia

• Lead intoxication
• Tumors

• Porphyria
• Lactose intolerance

• Functional abdominal pain
• Irritable bowel syndrome

• Appendicitis
• Intussusception
• Biliary colic

• Inflammatory bowel disease
• Peptic ulcer disease
• Mesenteric adenitis

• Meckel diverticulum
• Ureteropelvic junction (UPJ) obstruction

• Constipation
• Abdominal epilepsy [but has a shorter duration of pain (minutes), altered consciousness during event, abrupt onset, abnormal discharges in EEG in 80%]

• Pain usually lasts less than 6 hours.
• Pain can be located anywhere in abdomen, but more often in upper quadrants.
• No abdominal pain between attacks
• Repetition of identical abdominal crises, anywhere from one per week to several times a year
• Migraine in relatives
• Presence of other migraine-like syndromes such as nausea, vomiting, perspiration, body temperature changes, focal paresthesias, radiation of pain to a limb, malaise
• Absence of impaired consciousness

Test: CBC, differential, sedimentation rate, urinalysis (to exclude alternative diagnoses)
Significance: R/O infection, i.e., UTI

Test: Stool heme test, and stool for culture
Significance: IBD, GI causes of pain

Test: Lactose breath test
Significance: Lactose intolerance

Test: Lead test, porphyria work-up (depending on situation)
Significance: Poryphyria

Test: EEG
Significance: May help differentiate between abdominal migraine and abdominal epilepsy

Test: Visual evoked response (VER) to red and white flash light
Significance: May be helpful in diagnosing abdominal migraine, as children with clinically diagnosed abdominal migraine display a specific fast-wave activity response compared to normal controls, or children with migraine headaches alone

Test: Obstruction series
Significance: Intermittent or partial bowel obstruction

Test: Upper GI
Significance: To rule out anatomical abnormalities

Test: Ultrasound
Significance: To rule out tumor, chronic appendicitis, etc.

Test: Renal ultrasound
Significance: To rule out UPJ obstruction

Test: Barium enema
Significance: During painful crisis to rule out intussusception

• Tricyclic antidepressants, serotonin receptor antagonists or beta blockers, used as in prophylactic treatment of migraine headaches
• Ergotamine, antihistamines, as in abortive medical treatment of migraine headaches

• Abdominal migraine is a diagnosis of exclusion; even if a patient meets most criteria for abdominal migraine, alternative diagnoses should be considered and tested for as appropriate to ensure that a more serious disorder does not exist.
• Patients may go through an unnecessarily extensive work-up to rule out other causes of pain, sometimes including laparotomy.
• Absence of objective abnormalities on laboratory testing does not necessarily indicate neurosis in the patient/family.
• Medications must be given on a daily basis, as they are used in a prophylactic fashion. For the majority of patients, side effects and complications from the use of medications may outweigh the relief of pain, especially in children who are experiencing infrequent episodes.

Q: Does this mean my child will develop migraine headaches?
A: There is an association between abdominal migraines in childhood and migraine headaches in later life. There is no good way to predict for sure whether your child will experience migraine headaches.

Q: I have two other younger children. What chance do they have of developing abdominal migraines?
A: Although abdominal migraines do tend to run in families, there is no known Mendelian inheritance pattern, as opposed to a disease such as cystic fibrosis, for which a probability can be given.

Q: What can I do to help my child during bouts of pain?
A: The parent should allow the child to do whatever makes him or her comfortable. This may mean rest, positioning, quiet, etc. Acetaminophen and other pain relievers may help to a certain degree. Whether the patient should be excused from school depends on various factors, such as the frequency, severity, and duration of the pain, as well as the age, maturity, and coping skills of the child.

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