When we think about migraines we typically think of strong (and sometimes reoccurring) headaches that seem to strike out of the blue. But not all migraines will present with head pain—some migraines (like silent migraines) can occur with no headache at all. And then there are abdominal migraines, which occur in another part of your body altogether: your stomach.
But what is abdominal migraine, and how do you treat it? Here, experts share abdominal migraine symptoms, treatments, and everything you need to know about the painful condition often seen in children.
What is an abdominal migraine?
Much like their name indicates, abdominal migraines create recurring episodes of gastrointestinal symptoms, according to Morgan Sendzischew Shane, M.D., M.S.C.T.I., gastroenterologist and assistant clinical professor, division of digestive health and liver diseases at the University of Miami Health System. While they are most likely to occur in patients who already suffer from migraines, some people may experience abdominal migraines without any history of migraine symptoms—and sometimes without even the tell-tale headache that normally accompanies a migraine. According to the American Migraine Foundation, attacks can last from two to 72 hours, and a person often has no symptoms between attacks. And, interestingly, the disease is mostly seen in children.
What causes abdominal migraines?
Like other migraine syndromes, James S. Leavitt, M.D., F.A.C.G., gastroenterologist and director of clinical quality and outcomes, Gastro Health says that the root causes of abdominal migraines remain unclear. “It is thought that some imbalance or change in histamine and serotonin causes these events,” he says.
While medical experts aren’t exactly certain what brings on this kind of attack, they do know that some external factors are more likely to bring on symptoms. “Triggers are fairly common and could include stress, weather, hormonal menstrual changes, and certain food triggers such as chocolate, caffeine, MSG, processed meats with nitrites, and wine, among others,” he says, adding that abdominal migraine suffers can benefit greatly from creating a “migraine” diary to help identify their personal triggers.
Discovering what causes these types of migraines can be especially important in younger patients, according to Stephen Thompson, M.D., associate professor of pediatric neurology at the University of Maryland School of Medicine, and pediatric neurologist with the University of Maryland Children’s Hospital. “These often convert to true migraine with headache as the child gets older,” he says.
Abdominal migraine symptoms
Abdominal migraines may present with a prodrome (or an early symptom) of nausea, vomiting, pallor, flushing, yawning, drowsiness, and decreased appetite, explains Dr. Leavitt. “The hallmark symptom is, as expected, abdominal pain.” Patients may feel this pain around or behind their belly button. “It is usually dull, constant, intense, and can last anywhere from an hour to several days.”
How to diagnose an abdominal migraine
Dr. Sendzischew Shane says diagnosis can be tricky. “The key is a good history. Asking detailed questions about symptom complex, frequency of symptoms, symptom-free periods, etcetera can really help clinch the diagnosis,” she says. “There are no specific tests that confirm this diagnosis, but testing can be done to rule out other illnesses that can sometimes present similarly.”
All of this may be part of the reason why Dr. Leavitt says people can suffer from their symptoms for a long time before getting an answer. “It is not uncommon to have a delay in diagnosis of up to two years,” he says, adding that the criterion for diagnosis includes at least five attacks with no symptoms in between the attacks, and no other recognizable causes for these painful events. “While gastroenterologists frequently evaluate patients with abdominal pain, once a diagnosis of abdominal migraines is made, neurologists more typically become involved in the long-term treatment.”
Treatment and prevention
When it comes to dealing with the symptoms of abdominal migraine, Dr. Thompson says it’s all about managing your discomfort. “Treatment of abdominal migraine is essentially symptomatic: anti-nausea medications such as Zofran, hydration, pain medications, and rest.”
And if you’re experiencing abdominal cramping, Dr. Sendzischew Shane says you may need to add an antispasmodic medication to your treatment plan. “It really has to do with the particular symptom complex the individual patient experiences,” she says.
Of course, nobody likes dealing with these types of GI symptoms, which is why prevention is best. “Once a diagnosis has been established, patients who can recognize the onset of symptoms early may be prescribed medications that stop the progression, similar to those used in migraine,” says Dr. Sendzischew Shane. “The key is to recognize symptoms early and kind of ‘nip it in the bud.’”
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