If your child frequently complains of unexplained stomach pain and nausea lasting a few hours to a few days, abdominal migraines may be the culprit.
An abdominal migraine is a type of migraine that causes a dull or achy pain around the stomach, rather than in the head. The condition is somewhat rare, affecting between 2% and 5% of children and 1% of adults. Children between ages 2 and 10 are most often affected, and the condition may be linked to stress and anxiety.
Rina M. Sanghavi, M.D., FAAP, Director of Neurogastroenterology and GI motility at Children's Health℠ and Associate Professor of Pediatrics at UT Southwestern, says most children outgrow abdominal migraines by adolescence. However, many children with the condition go on to develop migraine headaches in adulthood.
What are the symptoms of abdominal migraine?
The most common symptom is stomach pain around the belly button. Other symptoms include:
- Dry heaving
- Loss of appetite
- Pale skin
Some children may also experience migraine headaches that are not associated with their stomach pain.
If your child vomits, it is important to distinguish between abdominal migraine and cyclical vomiting syndrome, a condition that causes frequent vomiting that suddenly goes away.
Children who get abdominal migraines are symptom-free between episodes. The condition can be tricky to diagnose because symptoms are similar to other common causes of stomach aches.
"A 2-year-old may not be able to verbalize what is going on, so we keep abdominal migraines in the back of our minds as a possible condition to test for," says Dr. Sanghavi.
What causes abdominal migraines?
The exact cause of abdominal migraines is not fully understood, but doctors and researchers believe changes in hormones such as serotonin, changes in the neuroendocrine system and changes in the brain-gut connection can trigger attacks.
"The brain-gut connection plays a key role in abdominal migraines. Stress occurring early in life may predispose a child to conditions like abdominal migraine or irritable bowel syndrome," says Dr. Sanghavi.
Other possible causes of abdominal migraines include:
- Blood flow changes in the intestines
- Lack of sleep
- Irregular sleep patterns
The microbiome and abdominal migraines
The microbiome, the good and bad bacteria in our intestines, tells the brain when the body is healthy or not healthy. "Changes in the microbiome play a key role in gut health and can lead to abdominal migraines and other conditions such as irritable bowel syndrome," says Dr. Sanghavi.
Probiotics, the living "good" bacteria found in foods such as yogurt and cheese help maintain good bacteria in the intestines. The American diet is low in these nutrients, explains Dr. Sanghavi, preventing good bacteria from growing. Taking a lot of antibiotics can also disrupt the healthy balance in the gut and encourage the harmful bacteria to thrive.
Food and abdominal migraines
Some of the common foods that trigger migraine headaches can also cause abdominal migraines. They include:
- Monosodium glutamate (MSG)
- Nitrites (added to foods such as cold cuts)
Each child is affected by different foods. Dr. Sanghavi recommends patients or parents keep a food diary to help spot which foods trigger stomach pain.
How is an abdominal migraine diagnosed?
Even though abdominal migraine is more common in children, it is still a rare condition. It is important to see a pediatric gastroenterologist who can rule out other causes of abdominal pain first, such as:
Because a diagnostic test is not available to diagnose abdominal migraine, Dr. Sanghavi explains that doctors oftentimes make a diagnosis of exclusion, ruling out other conditions to arrive at a diagnosis.
What treatments are available for abdominal migraines?
Children receive treatments based on their symptoms, and the causes and triggers for their abdominal migraines.
Once your care team determines the stress, event or food that triggers the abdominal migraine, they will work to remove that source of stress and reduce your child's pain. Your doctor might suggest medications to relieve pain or medications used to treat migraines. It is important to know that some medicines may not work for your child, so talk to your doctor about options.
"Remember that the medicines stop an attack, but they do not prevent one," says Dr. Sanghavi. To prevent an abdominal migraine, work with your child to monitor and reduce stress and avoid eating trigger foods.
Other treatments include:
- Sleep. Many migraines go away after a restful sleep.
- Relaxation techniques, such as:
- Cognitive behavioral therapy
- Guided imagery
"Stress cannot always be controlled, but we can teach a child how to control their body's response to stress," says Dr. Sanghavi. "We recognize that some children need help relaxing."
Children likely outgrow abdominal migraines, but may develop migraine headaches during adolescence or adulthood. "Managing migraines is not a sprint, but a marathon," says Dr. Sanghavi. "We help families make lifestyle changes now that will last for life."
If you have questions about abdominal pain or other gastrointestinal issues, the experienced GI specialists at Children's Health can work with your pediatrician to identify, diagnose and treat digestive issues in children. Learn more about our programs and services.