Abdominal migraine

• Abdominal migraine:

  • Cause of recurrent episodes of central abdominal pain
  • Often occur in children aged 3-10 years
  • More common in girls
  • Children with abdominal migraine are more likely to develop traditional migraine headaches as adult
• No underlying physical pathology will be present on examination or investigations.
• The episodes may have triggers, such as stress, lack of sleep, dehydration, certain foods and bright lights.
• Presentation:

  • Episodes of periumbilical abdominal pain lasting 1 hour - 3 days
  • Nausea and vomiting
  • Anorexia
  • Pallor
  • Headache
  • Photophobia
  • Aura - visual changes or tingling sensation in the hands
• Treating the acute attack may involve:

  • Low stimulus environment (e.g., a quiet dark room)
  • Paracetamol
  • Ibuprofen
  • Triptans (e.g., sumatriptan)
• Longer-term preventative medications include:

  • Pizotifen (serotonin antagonist)
  • Propranolol (non-selective beta blocker)
• Pizotifen needs to be withdrawn slowly when stopping as it is associated with withdrawal symptoms of depression, anxiety, poor sleep and tremors.