Medical mystery: Yale doctors solve woman’s chronic abdominal pain

You may have heard of, or experienced, migraine headaches--recurrent attacks of pulsating pain that often occur on one side of the head. Abdominal migraine, though, is less common and poorly understood. Most often diagnosed in children, this condition, characterized by stomach pain, nausea, and vomiting, can lead to absences from school, emotional distress, and a disruption in normal activities.

The cause of abdominal migraine remains a mystery, as does the condition’s relationship to migraine headaches, though children with abdominal migraine often have a family or personal history of migraine headaches, find relief with migraine medications, and share similar triggers and symptoms. Evidence also suggests that as children with abdominal migraine age, their abdominal migraines evolve into classic migraine headaches.

Abdominal migraine and classic migraine share similar triggers, such as stress, skipping meals, exposure to bright light, poor sleep, and foods containing chocolate, caffeine, and monosodium glutamate (MSG). Because there are so few studies on medications used to treat abdominal migraine, patients with the condition are often treated with medications shown to be effective on a classic migraine. 

The cause of abdominal migraine is unknown. "We don’t know the exact connection between an abdominal migraine and a classic migraine, but we do know there’s a connection between the gut and the brain," says Deena Kuruvilla, MD, a neurologist and specialist in facial and headache pain at Yale Medicine. "Many of the drugs we use to treat depression, for example, are effective in treating an abdominal migraine."

Abdominal migraines mostly affect children--around 4% of children experience an abdominal migraine, with the first episode occurring between 3 and 10 years old. Most children seem to outgrow the condition, though abdominal migraines in adulthood are just starting to be studied. A child with a family or personal history of migraine headache has an increased chance of developing abdominal migraine. 

The main symptom of abdominal migraine are recurrent episodes of moderate to severe stomach pain that lasts for between 1 and 72 hours. Other symptoms can include nausea, vomiting, loss of appetite, and pale appearance. (These symptoms rarely occur between episodes.) 

There is currently no test to confirm abdominal migraine. Your doctor will make a diagnosis based on specific criteria that details the type, frequency, and severity of symptoms associated with abdominal migraine. The diagnosis will typically be made only after all other causes of abdominal pain have been ruled out. 

Once a child is diagnosed with abdominal migraine, treatment generally falls into two categories: relieving symptoms during an episode and preventing future episodes.

While there are few studies on the treatment and management of abdominal migraine, doctors may prescribe the following medications, based on their usefulness in treating migraines:

  • NSAIDs (such as ibuprofen) or acetaminophen to relieve the pain.
  • Triptans. This family of drugs is commonly used to treat migraine headaches and, if taken as soon as a migraine starts, can prevent symptoms from progressing.
  • Anti-nausea medication. Anti-nausea drugs act by blocking chemicals in the brain that trigger vomiting.

Some studies have shown evidence to support the use of the following medications in preventing abdominal migraine:
  • Pizotifen, a benzocycloheptene-based drug.
  • Flunarazine, a calcium channel-blocking agent.
  • Cyproheptadine, an anti-histamine.
  • Propranolol, a beta blocker with potentially serious side effects, including depression and hypertension.

As with classic migraine headaches, one of the main ways to prevent future abdominal migraines is to avoid triggers. Parents, children, and doctors can work together to identify specific triggers and devise strategies to help children avoid them. 

At the Yale Medicine Headache & Facial Pain Center, we have an acute treatment unit, which provides intravenous infusions for severe, disabling headaches as a convenient, efficient, patient-centered and effective alternative to emergency department. Our neurologists specialize in treating headaches and facial pain in adolescents and adults. We are sensitive to the needs of each patient, tailoring treatment options to individual needs.

Our doctors also conduct research to understand the underlying biology of headache disorders and new possibilities for treatment. 

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