NATIONAL HARBOR, MD. — Abdominal migraine may be responsible for up to 15% of all cases of idiopathic recurrent abdominal pain in children, according to an analysis of records from more than 400 children.
Abdominal migraine is an idiopathic disorder characterized by moderate to severe midline abdominal pain lasting 1–72 hours associated with vasomotor symptoms, nausea, and vomiting. It is recognized by the International Headache Society (IHS) as being among the “periodic syndromes of childhood that are commonly precursors of migraine” (Cephalagia 2004;24:suppl 1:9–160).
Most of the literature on the topic is from Europe, and the diagnosis is far more common there than it is in the United States, where it is largely underdiagnosed, Dr. Laura D. Carson and her associates said in a poster she presented at the annual meeting of the North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition.
In a retrospective chart review of 600 children and young adults (ages 1–21 years, 59% female) who were referred to a pediatric gastroenterologist during 2006–2007 for recurrent abdominal pain, 23.5% (141) were excluded because of a preexisting diagnosis. Of 458 who met inclusion criteria, 4% (20) met the IHS diagnostic criteria for abdominal migraine (see box), while another 11% (50) were considered probable diagnoses of abdominal migraine with documentation lacking for at least one diagnostic criterion. The remaining 85% (388) did not meet the criteria, said Dr. Carson and her associates, of Eastern Virginia Medical School and Children's Hospital of the King's Daughters, both in Norfolk, Va.
No relationship has been identified among those with abdominal migraine and those who had family histories of either abdominal pain or headache. However, children who met the abdominal migraine criteria were four times more likely to have migraine headaches.
Despite its inclusion in both the IHS classification as well as the 2006 Rome III GI Criteria (Gastroenterology 2006;130:1527–37), abdominal migraine is infrequently considered in the differential diagnosis of recurrent abdominal pain in children. Expertise in migraine lies with neurologists, who are rarely called upon to evaluate abdominal pain.
Abdominal migraine occurs only in children, whereas in adulthood it presents to neurologists as classic migraine headache. Children with recurrent abdominal pain often are referred to gastroenterologists, who rule out other organic causes but might not consider migraine as an etiology, Dr. Carson said.
“Given the spectrum of treatment modalities now available for pediatric migraine, increased awareness of cardinal features of abdominal migraine by pediatricians and pediatric gastroenterologists may result in improved diagnostic accuracy and early institution of both acute and preventative migraine-specific treatments,” Dr. Carson and her associates said in their poster.
The study was funded by the Children's Specialty Group Chairman's Fund, based at Children's Hospital of the King's Daughters, Norfolk. Dr. Carson stated that she had no other disclosures.
Criteria in Brief
At least 5 attacks fulfilling criteria B-D.
Attacks of abdominal pain lasting 1–72 hours.
Abdominal pain has all of the following characteristics:
Midline, periumbilical, or poorly localized.
Dull, or “just sore” quality.
Moderate or severe intensity.
During abdominal pain, at least two of the following:
Anorexia.
Nausea.
Vomiting.
Pallor.
Not attributed to another disorder.
Note: ROME criteria are similar, but also specify intervening periods of usual health and include headache and photophobia among the possible symptoms during abdominal pain.
Source: 2004 International Classification of Headache Disorders