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The secret hidden in the gut-brain connection: How do abdominal migraines develop?
Abdominal migraine (AM) is a functional disorder that usually occurs in children and adolescents and lacks clear pathological mechanisms or biochemical abnormalities. Many children often experience severe central abdominal pain, along with migraine symptoms such as nausea, vomiting, severe headaches, and general paleness. The diagnosis of abdominal migraine is based on clinical criteria and exclusion of other disorders; however, the U.S. Food and Drug Administration has not approved any drugs for its treatment. The goal of treatment is usually to prevent attacks, which is usually achieved through nonpharmacological interventions.
Research shows that the incidence of abdominal migraine in children falls between 0.4% and 4%, mainly affecting children aged 3 to 10 years old, and the prevalence is higher in women.
Symbol symptoms
The distinguishing features of abdominal migraine include midline abdominal pain, often accompanied by paroxysmal, recurring acute attacks lasting an average of 17 hours. Reports indicate that these episodes can last anywhere from two to 72 hours. Although the pain has also been described as diffuse and cramping, it is usually dull and centered primarily around the belly button.
91% of patients showed loss of appetite, 73% to 91% were accompanied by nausea, 35% to 50% had vomiting, and 93% to 100% of patients had symptoms of pallor.
A seizure usually ends suddenly. The average number of attacks per year is approximately 14. Abdominal migraine attacks are usually episodic, although nonspecific prodromal symptoms may precede an attack. These symptoms include behavioral and mood swings, loss of appetite, flushing, diarrhea, and possible auras such as numbness, slurred speech, tingling in the limbs, and flashes of light.
Potential causes and risk factors
Abdominal migraine is thought to be related to specific changes in the gut-brain axis. In addition, vascular dysregulation, changes in the central nervous system, and genetic factors may also influence it. Psychological factors such as emotional abuse and stressful events are also considered risk factors for recurrent abdominal pain, and research shows that children with functional gastrointestinal disorders are more likely to develop mental health problems such as anxiety and depression than those without these disorders.
Any stress in life, such as work and family life, irregular sleep, prolonged fasting, dehydration, etc., can be a trigger for abdominal migraines.
Diagnosis and differential diagnosis
When diagnosing abdominal migraine, it is critical to rule out organic disease. A complete medical history and physical examination are essential to confirm the diagnosis. It is also necessary to carefully check for possible warning signs, including visible or occult bloody stools, difficulty swallowing, bloody vomiting, fever, changes in growth patterns, etc.
According to the Rome IV criteria, abdominal migraine is diagnosed in patients with at least two episodes of acute abdominal pain within a six-month period, and these episodes must significantly interfere with daily activities.
Treatment methods
There are currently no clear recommendations in the literature for the treatment of abdominal migraine, and most treatment options are based on the experience of small groups of children and a few studies. Doctors often use the "STRESS" mnemonic to remember treatment points, which include stress management, travel advice, rest, warning signs, avoidance of flashing lights, and snack recommendations.
While there have been no randomized trials evaluating the efficacy of biofeedback and coaching in the treatment of abdominal migraine, these interventions are thought to be potentially helpful in alleviating emotional stress. For some patients with migraines and irritable bowel syndrome, an IgG-based elimination diet has shown potential to reduce migraine attacks. In general, the evidence for dietary effects on seizures in children is weak.
Prognosis and epidemiology
Abdominal migraine has a considerable impact on daily life, and children may miss school or participate in other activities. For many patients, the condition resolves with growth. First described in 1921, this condition was considered a controversial diagnosis in the past but is now accepted as one of the common causes of chronic abdominal pain in children.
Abdominal migraine is diagnosed at an average age of 7 years, but is more common in adolescents and in female patients. So, in the face of such diverse symptoms and backgrounds, how to accurately identify and effectively treat abdominal migraine will become the focus of future research?
