Abdominal Migraine
Abdominal Migraine: An Under-Diagnosed Cause of Recurrent Abdominal Pain in Children
Headache 2011;51:707-712
Division of Pediatric Neurology, Children’s Hospitalof The King’s Daughters, Norfolk, VA, USA.
This article is a useful reminder that Abdominal Migraine is a distinct entity in the known spectrum of functional abdominal pain.
Diagnostic criteria for abdominal migraine include all of the following, with 2 or more episodes in the preceding 12
months:
A. Paroxysmal episode of intense, acute periumbilical pain that lasts 1 hours or more.
B. Intervening periods of usual health lasting weeks to months.
C. The pain interferes with normal activities.
D. The pain is associated with 2 or more of the following:
a. Anorexia.
b. Nausea.
c. Vomiting.
d. Headache.
e. Photophobia.
f. Pallor.
E. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process.
A key feature of AM is the complete resolution of symptoms between attacks
It joins functional dyspepsia, irritable bowel syndrome, and functional abdominal pain syndrome in this spectrum.
It is a useful diagnosis to recognize because it may respond well to dietary, lifestyle, and pharmacological interventions as used in migraine headache. Preventive medications that have demonstrated efficacy in clinical trials include pizotifen, propranolol, and cyproheptadine.
The article is available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4610.2011.01855.x/abstract
Cheers
Mike
Objective.—Our objective was to demonstrate that, despite recognition by both the gastroenterology and headache communities, abdominal migraine (AM) is an under-diagnosed cause of chronic, recurrent, abdominal pain in childhood in the
USA.
Background.—Chronic, recurrent abdominal pain occurs in 9-15% of all children and adolescents. After exclusion of
anatomic, infectious, inflammatory, or other metabolic causes, “functional abdominal pain” is the most common diagnosis
of chronic, idiopathic, abdominal pain in childhood. Functional abdominal pain is typically categorized into one,or a combination
of, the following 4 groups: functional dyspepsia, irritable bowel syndrome, AM, or functional abdominal pain syndrome.
International Classification of Headache Disorders—(ICHD-2) defines AM as an idiopathic disorder characterized by
attacks of midline, moderate to severe abdominal pain lasting 1-72 hours with vasomotor symptoms, nausea and vomiting, and
included AM among the “periodic syndromes of childhood that are precursors for migraine.” Rome III Gastroenterology
criteria (2006) separately established diagnostic criteria and confirmedAMas a well-defined cause of recurrent abdominal pain.
Methods.—Following institutional review board approval, a retrospective chart review was conducted on patients referred
to an academic pediatric gastroenterology practice with the clinical complaint of recurrent abdominal pain. ICHD-2 criteria
were applied to identify the subset of children fulfilling criteria for AM. Demographics, diagnostic evaluation, treatment
regimen and outcomes were collected.
Results.—From an initial cohort of 600 children (ages 1-21 years; 59% females) with recurrent abdominal pain, 142 (24%)
were excluded on the basis of their ultimate diagnosis. Of the 458 patients meeting inclusion criteria, 1824 total patient office
visits were reviewed. Three hundred eighty-eight (84.6%) did not meet criteria for AM, 20 (4.4%) met ICHD-2 formal criteria
forAM and another 50 (11%) had documentation lacking at least 1 criterion, but were otherwise consistent withAM (probable
AM). During the observation period, no children seen in this gastroenterology practice had received a diagnosis of AM.
Conclusion.—Among children with chronic, idiopathic, recurrent abdominal pain,AM represents about 4-15%. Given the
spectrum of treatment modalities now available for pediatric migraine, increased awareness of cardinal features of AM by
pediatricians and pediatric gastroenterologists may result in improved diagnostic accuracy and early institution of both acute
and preventative migraine-specific treatments.
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
Mike
Prof Mike South,
Royal Children's Hospital, Parkville, Victoria 3052, Australia
