Abdominal Migraines In Adults
Why Is This Important?
Abdominal migraines are a condition specifically associated with children in the age bracket of 3-10 years old (SOURCE with the peak diagnosis being at 7 years old (Paediatric Health, Medicine and Therapeutics)
But there are rare cases in which we do find abdominal migraines in adults.
We review that information available and discuss your options if you think you might be suffering as an adult with an abdominal migraine.
The 'Child's Migraine' That Affects Adults Too...
What Is An Abdominal Migraine And How Does It Affect Adults?
As the name suggests, an abdominal migraine is a migraine where the principle focus is stomach pain, rather than a ‘migraine headache’, where the focus is of course, mostly on your head.
Abdominal migraines do not get much coverage and, because the symptoms can be very similar to much more common conditions, are often confused with IBS, peptic ulcers or other GI problems.
The vast majority of sufferers are children, which makes it a very difficult area for the clinician, typically because it relies on strong, definitive symptom information from the patient and this is often not forthcoming from children.
Why Is It Even Called A ‘Migraine’?
The crippling stomach pain of abdominal migraines are classified as ‘migraines’, in part due to the very high percentage of children that go on to develop migraine headaches as adults (as well as certain common symptoms).
A clinical trial in the ‘Archives Of Disease In Childhood’ reported a figure of 52% of paediatric sufferers going on to develop migraine headaches within 7-10 years.
The good news for children who suffer with abdominal migraines is that they generally cease with age, so symptom control is the main goal as time will cause them to stop
However, there are rare cases of adults that suffer with abdominal migraines, and there is no guarantee in these cases, that you will just ‘grow out’ of them in the way a 7 year old might.
So if you have excruciating stomach cramps and abdominal pain, what do you need to know?
Symptoms Of An Abdominal Migraine In Adults
Well, the first thing to understand is that it is still quite likely that your stomach pain is NOT an abdominal migraine. Irritable bowel syndrome (IBS) actually shares many of the common symptoms of an abdominal migraine including migrainous headaches.
One study on IBS in The Canadian Medical Association Journal showed 50% of patients with IBS suffered regular headaches as an additional symptom.
In actual fact, while headaches can be a part of suffering an abdominal migraine, there is actually no guarantee you get them at all during painful attacks.
The most typical symptom, as the name suggests, is that of abdominal pain – more specifically pain around the centre of your stomach or belly button.
As backed up by The American Migraine Foundation, this pain should come in waves typically lasting from 2-72 hours but should be non-existent in between attacks.
Other potential symptoms (besides belly pain and potential headaches) include –
- Loss of Appetite
- General Discomfort/ Reduction In General Awareness
- Pale Skin
Causes Of An Abdominal Migraine In Adults
No-one really knows what causes abdominal migraines in adults.
We know there is a strong link to migraine headaches and a high chance of developing migraines in later life, although this is more frequently researched in children due to the much higher incidence of abdominal migraines infants (3-10 years old).
Perhaps one of the biggest clues to the existence of an abdominal migraine, is actually a family history of migraine headaches.
Once again, migraine headaches show a strong genetic link to past generations in the same family – and this is also true with abdominal migraines.
A number of theories abound as to what causes abdominal migraines in adults (or children for that matter). One centres around a malfunction in the communication between your brain and your GI tract.
Another one notes the high incidence of reduced gut motility
In sufferers (the speed at which food passes through your stomach). This was backed up by a study in BMC Gastroenterology.
However, whether this reduced gut motility was the cause of abdominal migraines or occurs as a result of abdominal migraines is not entirely clear. More research would be required to be able to make a defined comment on this.
Diagnosis Of Abdominal Migraines In Adults
Diagnosis is then typically completed through a process of exclusion – in other words, your doctor will try to rule out all other possible cause of abdominal pain
Only after they have been through a whole set of tests for peptic ulcers, Irritable Bowel Syndrome and other potential GI issues, then abdominal migraines may be considered.
This reflects the relative rareness of them as a condition – especially in adults.
Perhaps the biggest clues as to their existence will lie in your doctor’s review of your family history.
A family history of migraines and the lack of any symptoms between attacks are potentially key indicators of abdominal migraines.
However, with no actual test that can definitively confirm or deny an abdominal migraine, the diagnosis will always be one of exclusion. In other words, rule out all the other possibilities that we can test for first.
When the full GI health check comes back clear, then your doctor may start considering more alternative causes.
Your doctor will then use either what is known as the ‘Rome III Classification of Childhood Functional Gastrointestinal Disorders’ or criteria supplied by The International Headache Society (IHS) to classify what you are suffering with as potentially abdominal migraines.
Triggers For Abdominal Migraines In Adults
Not much is known about triggers in adult abdominal migraines – most studies are based around single person cases and not clear on what might cause a higher of attacks.
However, it is reasonable to assume that stress and anything that causes sudden change such as crash dieting, heavy drinking or menstruation may all have an effect.
Your diet may also have a significant impact on the frequency of attacks, but which foods/ liquids and how much of an impact each has is a largely personal experieince.
The best advice is to keep a detailed diary/ log of all the events/ foods and general experiences you have. After three or four abdominal migraines, you should be able to review your diary and start to spot patterns that seem to occur in the hours/ days before another attack.
The more abdominal migraines you have and the more detail you put in the diary entries you keep, the better your detection and control of your triggers will be.
Treatments For Abdominal Migraines In Adults
In young infants, abdominal migraines tend to fade and disappear, normally by the age of about 10. Partly for this reason and also concerns about drugs affecting their development, there is a deliberate move to avoid using drugs to control their symptoms.
In adults, this is not the case.
There is no guarantee that your abdominal migraines will disappear and drug therapy is common in all areas, so perceived as much less of a risk.
A case report in The Annals Of Pharmacotherapy recommended Topiramate as being successful both in that case and also 3 others that have been subject to clinical studies.
Topiramate is technically an anti-epileptic drug, but it has also been found to be effective in the treatment of migraines.
If this fails to calm your symptoms, then an abortive triptan therapy may be the answer. Triptans are well established in the treatment of severe migraines. This drug could be offered as an intravenous solution if sickness/ nausea is making swallowing tablets difficult.
Potential natural treatments for abdominal migraines in adults are not dissimilar to those use with children. These include
- Avoiding triggers
- Behaviour therapy
- Dietary Modifications
- Relaxation Techniques
- Hydration Therapy
By using a diary to plot all your activities (including the food/ drinks you consume) will highlight patterns of certain things linked to an increased number of attacks or a higher severity of attack.
We know that stress and sudden change increases the likelihood of suffering an abdominal migraine.
This is true with all migraines and is true in both children and adults alike.
Planning ahead can help to reduce the chances of sudden ‘stress points’ with looming deadlines or something you hadn’t thought about suddenly coming out of the woodwork.
Similarly, planning in time to rest or even just planning in a routine that allows for better sleep, can all reduce your stress levels.
A healthy diet can both reduce bloating/ gas and increase the gut motility that is strongly associated with abdominal migraines.
This doesn’t just mean eating healthy foods – eating softer foods that are easier to digest or probiotics that can help the breakdown of food could all have an impact.
Whether it be yoga, aromatherapy or self-hypnosis – whatever works for you. If you enjoy it and it helps you feel relaxed, then it will help your abdominal migraines.
This is a last resort, used when your abdominal migraines are long and intense, leaving you dehydrated and even malnourished.
Receiving fluids and nutrients via an IV drip will replace some of those key nutrients and help you to recover faster and fuller from attacks.
There is no data available for how frequent abdominal migraines are in adults. It is quite likely man go misdiagnosed or not diagnosed at all, because of their perceived rarity.
They are so rare that most clinical studies on abdominal migraines in adults are carried out as individual studies on single candidates.
This is no compensation for you though if you suffer with undiagnosed abdominal pains.
The Final Word –
Abdominal migraines in adults happen. Fact. We need to understand and accept this. Your average family doctor may not immediately consider them because they are rare – but so are many conditions.
There are key differences in abdominal migraines between children (the most common sufferers) and adults. This is true in the symptoms (they are more likely to involve headaches in adults), the prognosis (they are less likely to just stop in adults due to growth) and the treatment (adults are more likely to receive drug therapy as a 1st line choice).
In both cases however (adults and children), being able to describe your symptoms accurately is key to getting a successful diagnosis.
Planning and organisation is then key in both recognising your triggers and taking action to treat an abdominal migraine.
Working with your doctor and following these rules will then help you to achieve much better symptom control.
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References Used –
1. Jyoti Mani and Shailender Madani. (April 2018). Pediatric abdominal migraine: current perspectives on a lesser known entity. Paediatric Health, Medicine and Therapeutics.
2. F Dignan, I Abu-Arafeh, G Russell. (May 2001). The prognosis of childhood abdominal migraine. Archives of Disease In Childhood. BMJ Journals
3. W C Watson, S N Sullivan, M Corke, D Rush. (Feb 1978). Globus and Headache: Common Symptoms of the Irritable Bowel Syndrome. The Canadian Medical Association Journal
4. Resource Library. (Sept 2016). Abdominal Migraine. The American Migraine Foundation.
5. Niranga Manjuri Devanarayana, Shaman Rajindrajith, and Marc A. Benninga. (Feb 2016). Abdominal migraine in children: association between gastric motility parameters and clinical characteristics. BMC Gastroenterology.
6. Ashley E Woodruff, Nicole E Cieri, Jennifer Abeles and Stephanie J Seyse. (May 2013). Abdominal Migraine in Adults: A Review of Pharmacotherapeutic Options. Annals Of Pharmacotherapy.