ASK DR. H: Migraine that’s not in the head?

Q: My niece’s 3-year-old twin son suffers from abdominal migraines. His twin sister does not get them. There doesn’t seem to be a pattern as to when he’ll get sick. My niece says my mother suffered from migraines when she was living. Can you tell me more about these migraines? Are they hereditary? — J.N., Kennesaw

A: Most of my readers would be surprised to learn that there’s a type of migraine generally seen in young children that doesn’t cause a headache, or even involve the head. This uncommon “headless” migraine event is called an abdominal migraine.

It’s a difficult diagnosis to make because its symptoms — dull abdominal pain around the belly button region, nausea, vomiting, loss of appetite and occasional facial flushing — are often attributed to other things.

About 10 percent of healthy school-age kids will at some time experience recurrent episodes of abdominal pain. In only 10 percent of those kids is a medical problem actually found. Because of the difficulty in making the diagnosis, some with unexplained pain may have undiagnosed abdominal migraines.

Abdominal migraines peak between the ages of 5 and 9, although they can persist into adulthood. Fortunately, they do tend to subside into adulthood. These children are also at higher risk for traditional migraine headaches. And like traditional migraines, these do tend to run in families.

The diagnosis of abdominal migraine is made only after other medical conditions like an ulcer, gastritis, lactose intolerance, intestinal blockage, inflammatory bowel disease and irritable bowel syndrome have been ruled out through bloodwork, urinalysis, endoscopy and/or imaging tests.

It’s also important to inquire about family/school stressors, diet and bowel habits.

This is a migraine event that happens just like those in the head: There’s an initial constriction of the blood vessels that supply the abdomen (hence the pain), followed by dilation of those blood vessels (the cause for occasional flushing).

Once the cause of the pain is identified as an abdominal migraine, the treatments are much the same as in other forms of migraines. In children, sleep is particularly effective.

A pediatric neurologist is best qualified to prescribe preventive and abortive treatments.

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.

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4 comments Add your comment


February 23rd, 2010
8:50 pm

My seven year old son was diagnosed about two years ago with abdominal migraines. They are widely misdiagnosed, or just missed altogether. We are grateful to have gone to a pediatric GI specialist who recognized the problem right away. He now takes Periactin (an old school antihistamine) each night, and only suffers recurrences when he eats MSG.

Jesse's Girl

February 23rd, 2010
10:24 pm

My oldest daughter was diagnosed with this….after countless doc appts and a surgery when she was 9. She is 13 now and has them only occassionally as opposed to the weekly issues she had 3 years ago. Thank you for bringing this to light. It is a very real, scary and superbly frustrating ailment.


February 25th, 2010
11:46 am

This is very interesting to read. My son had these symptoms and after many months of tests, specialists and medication was told that he would just have to live with the pain. NO ONE even hinted at the diagnosis of abdominal migraines. I will pass along this article.


June 30th, 2010
4:00 pm

When my daughter was 3 yrs old we took her to a neurologist who diagnosed her with Hereditary migraines. My son never had a headach in his life, but had frequent stomach aches with no known medical cause. Both children are in their early 30’s now. I can’t help but wonder if my son was having stomach migraines back then and no one correctly diagnosed him.