What is an abdominal migraine?
Migraine headache is a neurological disorder that involves both headache pain, which can be severe, and other neurological or systemic symptoms (Dodick 2018, Irwin 2017). These symptoms can include sensitivity to light or sound (photophobia and phonophobia) and even touch, or the feeling of low mood or psychological distress. Other symptoms can involve the gut (Aurora 2021, Kim 2022), including nausea and even vomiting.
Abdominal migraines are basically the same as migraine headaches, except that the pain is in the gut, usually epigastric (around the stomach; upper left quadrant) or peri-umbilical (midline, belly button area). The pain is usually described “dull” or “just sore” (Irwin 2017) and can range from moderate in intensity to debilitating. These episodes can last from hours to days, but in between episodes, people are symptom-free (Angus-Leppan 2018, Irwin 2017, Rome Foundation 2021) and otherwise healthy.
Who is at risk for abdominal migraines?
Abdominal migraines were first recognized in children, and the Rome IV criteria for diagnosis of Functional Bowel Disorders/Disorders of Brain-Gut Interaction only lists it under Childhood Functional GI Disorders: Child/Adolescent (Rome Foundation 2021). Thus, abdominal migraine is usually considered a pediatric disorder. However, cases of abdominal migraines have been identified recently, although more rarely, in adults (Woodruff 2013). It is possible that abdominal migraines are in fact more common, but are underdiagnosed based on the assumption that it is a pediatric condition.
Among both children and adults, history of migraine headaches is common (up to 70%; Irwin 2017, Angus-Leppan 2018) and migraine headaches run strongly in families. Thus, abdominal migraines seem to follow from a genetic susceptibility. It is slightly more common in females (Angus-Leppan 2018).
What triggers an attack of abdominal migraine?
Triggers for abdominal migraine are similar to migraine headaches. These include stress, sleep loss, travel, or missed meals (Angus-Leppan 2018). Sometimes people report bright light or low moods as being triggers of abdominal migraine, but these are believed to represent early phases of the attack, rather than actual triggers (Angus-Leppan).
Why do we think abdominal migraines are related to migraine headaches?
There are lots of reasons! One is related to the close link of gut symptoms with migraine (Aurora 2021, Kim 2022), high rate of co-morbidity, and of intimate relationship of the gut and brain, especially where stress and pain are concerned. The overlap of symptoms, such as pain, photophobia, mood problems between both conditions argues for a similar pathophysiology. Both conditions are complex, with genetic, neurological, vascular, and immune/inflammatory contribution to the generation of symptoms. Although there is not much research specifically on pharmacological treatment for abdominal migraine, medications used for migraine headaches, including sumatriptan (for acute treatment) and pizotifen and topimirate (for prevention), have been reported to help abdominal migraines as well (Agnes-Leppan 2018, Woodruff 2013).