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Symptoms are terrifying! Why do children suffer so much from abdominal migraines?
Abdominal migraine (AM) is a functional disease that usually occurs in childhood and adolescence and has no clear pathological mechanism or biochemical abnormality. Many children experience episodic, severe central abdominal pain along with migraine symptoms such as nausea, vomiting, severe headaches, and paleness.
Diagnosis of abdominal migraine is based on clinical criteria and exclusion of other disorders. The U.S. Food and Drug Administration has not approved any pharmacological treatments for abdominal migraine, and the goal of treatment is primarily to prevent attacks, usually through nonpharmacological interventions.
Symptoms and manifestations
The main characteristic of abdominal migraine is midline abdominal pain, which attacks acutely and is intermittent, with an average duration of about 17 hours. Reports indicate that the duration of these episodes can range from two to seventy-two hours. Although the pain has been reported to be diffuse and colicky in nature, most patients describe the pain as dull and often localized around the umbilicus.
91% of patients showed anorexia, 73% to 91% felt nauseated, 35% to 50% vomited, and 93% to 100% were pale. Usually the attack ends abruptly.
Causes and risk factors
Abdominal migraine is related to specific changes in the gut-brain axis, vascular dysregulation, changes in the central nervous system, and genetic factors. Furthermore, psychological factors may influence the pathophysiology of abdominal migraine, especially in children who have experienced abuse or stressful events.
Triggers
Many typical triggers can lead to abdominal migraine attacks, including work- and family-related stress, irregular sleep patterns, prolonged fasting and food deprivation, dehydration, travel, and high-amine foods.
Genetics
Abdominal migraine and other migraines have a strong familial nature, and certain genetic mutations may involve genetic components of cell membrane transport (channelopathies).
Diagnosis
When diagnosing abdominal migraine, care needs to be taken to exclude organic disease as the source of the child's symptoms and to consider the patient's functional status. A complete medical history and physical examination are crucial, and any potential warning signs must be examined carefully.
Treatment
Because of the paucity of studies in the literature, there are not many recommendations for the treatment of abdominal migraine. Most therapies are based on experience and a few studies in pediatric populations. When treating abdominal migraines, doctors may find the STRESS mnemonic helpful, which stands for stress management, travel advice, rest, emergency symptoms, flashing lights, and avoiding certain snacks.
Although there are no specific randomized trials evaluating the effectiveness of biofeedback and counseling in the treatment of abdominal migraine, these interventions are thought to be potentially helpful if emotional stress is a factor in migraine.
Prognosis
Abdominal migraines can have a significant impact on daily life and children may miss school or other activities. Many patients eventually recover.
Epidemiology
Abdominal migraine mainly affects children and is a common cause of chronic abdominal pain, with an incidence rate as high as 9% or as low as 1%. The condition is relatively rare in adults, but children who are diagnosed may continue to experience migraines into adulthood.
Conclusion
Although abdominal migraine is now considered a common source of chronic abdominal pain in children, in-depth research on its pathogenesis and treatment is still necessary. Why do so many children still suffer from this painful symptom?
