Stomach bug, or abdominal migraine?

Does your child have a stomach bug? Depending on the symptoms and circumstances, she may have an abdominal migraine. Here’s how to tell the difference between an abdominal migraine and a garden-variety stomach bug.

What is an abdominal migraine?

An abdominal migraine is like a migraine headache, but the pain is in the belly — not in the head. It’s most common in children ages four to 15 years old, but adults can get them as well. People may get an abdominal migraine every few weeks to every few months.

What are the symptoms of an abdominal migraine?

Patients describe abdominal migraine pain as “dull” or “sore.” It’s usually felt near the belly button.

Unlike a typical bellyache, however, people describe abdominal migraines as intense pain that subsides after about two hours.

Other symptoms include:

• Vomiting. According to Children’s Hospital of Wisconsin, about half the children with abdominal migraine meet the criteria for cyclic (severe, recurring) vomiting.
• Nausea (often intense)
• Loss of appetite
• Pale skin
• Fatigue, listlessness, malaise

What causes abdominal migraines?

Doctors aren’t sure of the exact cause. Some doctors suggest changes in the levels of histamine and serotonin influence abdominal migraines. Anxiety, stress, excitement, change in sleep patterns, going too long without eating and even certain foods may trigger abdominal migraines. Common food triggers include:

• Chocolate
• Cheese
• Chinese food that contains MSG
• Preserved meats that contain nitrites, such as hot dogs and sausages

How is abdominal migraine diagnosed?

Like migraine headaches, no specific tests diagnose abdominal migraine.

The International Classification of Headache Disorders (ICHD) states at least five “pain episodes” are needed to confirm diagnosis. The International Headache Society says those pain episodes need to meet a majority of common symptoms and triggers, with “complete freedom” between attacks. They also have a pattern: same time of day, same duration, same feeling.

When diagnosing abdominal migraine, doctors may first want to rule out conditions with similar symptoms. These include kidney disorders, peptic ulcer, gall bladder inflammation, bowel obstruction, gastroesophageal reflux, Crohn’s disease, and irritable bowel syndrome.

Is there a connection between migraine headaches and abdominal migraines?

Children with abdominal migraines usually have a family history of migraine headaches. According to a review published in Pediatric Health, Medicine and Therapeutics, a history of migraine headache in a first-degree relative is described in 34 percent – 90 percent of patients.1

They’re also more likely to get migraine headaches when they get older. Between 24 percent and 47 percent of kids with abdominal migraine develop migraine headaches.2 Abdominal migraines are also more common in girls than boys.

What’s the treatment for abdominal migraine?

Doctors often treat abdominal migraine similarly to migraine headaches. Depending on the child’s age and the severity and frequency of the attacks, a doctor may start with non-drug treatments and progress to other therapies.

Education is the first step to feeling better. Sometimes, knowing the attacks will improve on their own, as well as knowing the triggers, will ease a child’s worries. Cognitive Behavior Therapy can also help manage chronic pain as well as the stress that may trigger an abdominal migraine.

In certain cases, doctors may prescribe over-the-counter anti-inflammatory medication, acetaminophen and/or antinausea medication. Sumatriptan, used to treat migraines in adults, taken as a nasal spray, has shown some success  in children with abdominal migraine.3 Other possible treatments include tricyclic antidepressants; Valproic acid, an antiseizure medication; and ergotamine medications, which doctors also prescribe for adult migraines.

Managing abdominal migraines

Ask kids to write down (or help them write down) when the pain occurs and how long it lasts. They should also record what they ate earlier in the day, what happened at school or with friends, and anything that may have made them feel stressed or anxious.

Kids with abdominal migraines should make sure to eat a healthy, fiber-filled diet. Regular exercise and adequate sleep will also help lesson the odds of an attack. If you suspect stress or anxiety triggers abdominal migraines, help your child figure out what to do when he or she is really upset, worried or nervous.

Abdominal migraine is a common but under-recognized cause of tummy troubles in children. Although it’s painful in the moment, the condition should resolve in time.

Reviewed by Dr. Mona Dave  on 1/28/2019. Dr. Dave has Diplomate Certification in Pediatric Gastroenterology from the American Board of Pediatrics.  

Resources

1, 2. Mani J, Madani S. Pediatric abdominal migraine: current perspectives on a lesser known entity. Pediatric Health Med Ther. 2018;9:47-58. Published 2018 Apr 24. doi:10.2147/PHMT.S127210

3. Kakisaka, Y., Wakusawa, K., Haginoya, K., Saito, A., Uematsu, M., Yokoyama, H., … Tsuchiya, S. (2010). Efficacy of Sumatriptan in Two Pediatric Cases With Abdominal Pain-Related Functional Gastrointestinal Disorders: Does the Mechanism Overlap That of Migraine? Journal of Child Neurology, 25(2), 234–237. https://doi.org/10.1177/0883073809336875