Kids: belly pain could be a migraine

A child who suffers from mysterious abdominal pain might have a variety of migraine, according to a new study.

Abdominal migraine is a common diagnosis in Europe and the UK, but it's not made in the US very often, one of the study's authors told. "A lot of health care providers don't know this exists."

"There are lots of kids that have recurring unexplained abdominal pain, and when a kid is continually having these bouts of pain, sometimes there's no obvious cause found," said Dr Donald Lewis from the division of paediatric neurology at the Children's Hospital of the King's Daughters in Norfolk, Virginia.

Abdominal migraine

Dr Lewis told that abdominal migraine affects about two out of 100 kids and is usually treated with painkillers and diet.

He and his colleagues reviewed the medical charts of more than 450 kids and teens with recurrent abdominal pain. They checked the kids' symptoms against a list of criteria for abdominal migraine, including at least five attacks of abdominal pain that last at least an hour, pain in the middle of the belly, nausea, vomiting, and paleness. Attacks can last up to 72 hours.

About 4% of subjects met the criteria for abdominal migraine. Another 11% missed just one of the criteria and were considered "probable" abdominal migraine.

These kids accounted for just 15% of the cohort with chronic belly pain, but that's not insignificant, Dr Lewis said. "We're not dealing with a rare disease."

The causes

What causes even the more familiar migraine headache is poorly understood. The leading theory is that abnormal cell activity along certain brain pathways triggers pain and blood vessel changes in the head.

An abdominal migraine is the same thing as a migraine in the head, but instead it's felt in the stomach, Dr Lewis said. Kids generally outgrow them, but many do go on to have migraine headaches as adults.

The study was published online 11 March in the journal Headache.

60% of kids who met the formal criteria for abdominal migraine had family members who suffered from migraines.

Many parents of kids with abdominal migraines assume the condition is serious, because the kids "look ghastly pale, usually," said Dr George Russell, a retired professor of child health at the University of Aberdeen in Scotland.

"It's no more life-threatening than a migraine, but equally unpleasant and uncomfortable," Dr Russell, who did not work on the study, told.

Avoid migraine trigger foods

He generally advises kids to avoid foods that typically trigger migraines, many in the 'foods that start with c' category: cheese, chocolate, caffeine, citrus fruits, and Chinese food, among others.

"It's also helpful to take the attack seriously, and to try to sleep it off," Dr Russell said.

Acute attacks can also be treated with antacids or painkillers, Dr Lewis said. "But if kids have recurrent attacks, there is a group of medications that they can take daily to keep these attacks from coming," he said.

These include cyproheptadine (Periactin), topiramate (Topamax), and amitriptyline (Vanatrip, Elavil, or Endep). The FDA currently has warnings out on the increased risk of suicidal thoughts in kids and teens on antidepressants such as amitriptyline, and the drug is not recommended for patients younger than 12.

Abdominal migraines have been known in the UK for years, Dr Russell said, and "it's very nice to see the Americans waking up to it."

"Hopefully, this will alert people who take care of kids that maybe the reason that the fifteenth antacid hasn't worked is that it might be something else," Dr Lewis said.

 (Reuters Health/ March 2011)

Migraines triggers

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