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Wednesday, June 6, 2018

Abdominal Migraines

I never knew that abdominal migraines even existed until a friend told me she was diagnosed with them. This intrigued me because I wondered if it was due to Gastroparesis or if it just made Gastroparesis worse? Since June is Migraine Awareness Month, I wanted to do some research on abdominal migraines and go from there, in order to understand it better, and to see if there is a connection between them and Gastroparesis.



Source: National Headache Foundation




According to The American Migraine Foundation,

"The Basics

Abdominal migraine is a form of migraine seen mainly in children. It is most common in children ages five to nine years old, but can occur in adults as well. Abdominal migraine consists primarily of abdominal pain, nausea and vomiting.

It is recognized as an episodic syndrome that may be associated with migraine, as links have been made to other family members having migraines and children who have this disorder often grow into adults with migraine. Most children who experience abdominal migraine grow out of it by their teens and eventually develop migraine headaches.

The pain associated with abdominal migraine is generally located in the middle of the abdomen around the belly button. It is often described as dull or “just sore” and may be moderate to severe. In addition to the pain, there can be loss of appetite, nausea, vomiting and pallor. The attacks last between 2-72 hours and in between attacks there should be complete symptom freedom.

Please refer to the International Classification of Headache Disorders 3rd edition (beta version) website for more information on the criteria used to diagnosis abdominal migraine: https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/


Diagnosis

As with any form of migraine, there is no diagnostic test to confirm abdominal migraine. Diagnosis is achieved by reviewing family and patient medical history, physical examination and performing investigations to rule out other causes of the symptoms.

Examples of other conditions that should be ruled out to arrive at a diagnosis of abdominal migraine include: urogenital disorders, kidney disorders, peptic ulcer, cholecystitis (gall bladder), bowel obstruction, gastroesophageal reflux, Crohn’s disease, and irritable bowel syndrome. If there is any alteration in consciousness, seizure disorders should also be ruled out.


Treatment

For acute treatment of abdominal migraine attacks, medications used for other forms of migraine are often employed. These include hydration therapy (particularly if there has been significant vomiting), NSAIDs, antinausea medication and the triptans. The choice of medications is somewhat affected by the age of the patient. When abdominal migraines are frequent, preventive therapies used for other forms of migraines can be explored. These include pizotifen, flunarazine, propranolol, cyproheptadine and topiramate.


Summary

Abdominal migraine is a sub-type of migraine seen mainly in children. It consists of episodes of abdominal pain with nausea, vomiting, loss of appetite or pallor. Between episodes, there should be no symptoms. Children with abdominal migraine generally go on to develop migraine headaches later in life. People suspected of having abdominal migraine should be carefully assessed by their doctor for an underlying cause as certain gastrointestinal, urogenital or metabolic conditions may mimic abdominal migraine.

Resources:
The International Headache Society. https://www.ichd-3.org/1-migraine/1-6-episodic-syndromes-that-may-be-associated-with-migraine/1-6-1-recurrent-gastrointestinal-disturbance/1-6-1-2-abdominal-migraine/

Gelfand AA. Episodic syndromes that may be associated with migraine: A.K.A. “the childhood periodic syndromes”. Headache. 2015;55(10):1358-1364.

Evans RW, Whyte C. Cyclic vomiting syndrome and abdominal migraine in adults and children. Headache. 2013;53(6):984-993."





Source: http://headacheandmigrainenews.com/6-key-stomachgut-terms-related-to-migraine/






It seems to me that it mimics a lot of the same symptoms of Gastroparesis. According to Healthline,

"What is an abdominal migraine?

An abdominal migraine is a type of migraine that affects mostly children. Unlike migraine headaches, the pain is in the belly — not the head.

Abdominal migraines often affect kids between ages 7 and 10, but sometimes adults can get them too. This type of migraine is uncommon, affecting between 1 percent and 4 percent of children.

An abdominal migraine can easily be confused with other, more common causes of stomachaches in children, such as irritable bowel syndrome (IBS) and Crohn’s disease.


Symptoms of this type of migraine

The main symptom of an abdominal migraine is pain around the belly button that feels dull or achy. The intensity of the pain can range from moderate to severe.

Along with the pain, kids will have these symptoms:

nausea
vomiting
appetite loss
pale skin

Each migraine attack lasts between one hour and three days. In between attacks, kids are healthy and have no symptoms.

The symptoms of an abdominal migraine are similar to those of many other childhood gastrointestinal (GI) conditions — that is, those involving the digestive system. The difference is that abdominal migraine symptoms come and go with days to months of no symptoms. Also, each episode of abdominal pain is very similar.


Causes and triggers of abdominal migraines

Doctors don’t know exactly what causes abdominal migraines. It could share some of the same risk factors as migraine headaches.

One of the theories is that abdominal migraines stem from a problem in the connection between the brain and GI tract. One very small study also found a link between this condition and slower movement of digested food through the intestines.

Abdominal migraines are more common in children who have close relatives with migraine headaches. One study found that more than 90 percent of kids with this condition had a parent or sibling with migraines.

More girls than boys get abdominal migraines.

Certain factors seem to trigger abdominal migraines, including stress and excitement. Emotional changes might lead to the release of chemicals that set off migraine symptoms.

Other possible triggers include:

nitrates and other chemicals in processed meats, chocolate, and other foods
swallowing excessive amounts of air
exhaustion
motion sickness



Treatment options

Some of the same medicines used to treat migraine headaches also help with abdominal migraines,


including:

nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin IB, Advil)
anti-nausea medicines
triptan migraine drugs, such as sumatriptan (Imitrex) and zolmitriptan (Maxalt), which are the only triptan drugs approved by the U.S. Food and Drug Administration (FDA) for children over 6 years old.
Other medicines used to prevent migraines may prevent abdominal migraines if your child takes them every day.


These include:

cyproheptadine (Periactin)
propranolol (Hemangeol, Inderal XL, InnoPran XL)
topiramate (Topamax, Qudexy XR, Trokendi XR), which is FDA approved for children over 12 years old
Be sure your child is getting enough sleep, eating regular meals throughout the day, and drinking plenty of fluids (without caffeine).

If your child is vomiting, give them extra fluids to prevent dehydration.

Certain foods — such as chocolate and processed foods — may set off abdominal migraines. Keep a diary of your child’s diet and migraine attacks to help you identify their trigger foods and avoid them in the future.

Cognitive behavioral therapy (CBT) can help relieve stress, which is thought to be another cause of abdominal migraines.



How are they diagnosed?

Doctors don’t have a test specifically for abdominal migraines. Your doctor will start by asking about your child’s medical history and your family’s medical history. Children with abdominal migraines often have family members who get migraines.

Then the doctor will ask about your child’s symptoms. Abdominal migraines are diagnosed in children who meet these criteria:

at least five attacks of abdominal pain that each last 1 to 72 hours
dull pain around the belly button that may be of moderate to severe intensity
at least two of these symptoms: appetite loss, nausea, vomiting, pale skin
no evidence of another GI condition or kidney disease
The doctor will also perform a physical exam.

Though usually ruled out by your child’s history and physical exam, tests such as ultrasound or endoscopy can be done to look for conditions that have similar symptoms, such as:

gastroesophageal reflux (GERD)
Crohn’s disease
IBS
bowel blockage
peptic ulcer
kidney disease
cholecystitis


Complications of abdominal migraines

Abdominal migraines can be severe enough to keep children out of school for a few days at a time. Because this condition is easy to mistake for other GI diseases, kids who are misdiagnosed may end up undergoing unnecessary procedures.


Outlook
Kids usually grow out of abdominal migraines within a year or two. However, up to 70 percent of these children will go on to develop migraine headaches when they grow up. Some will also experience abdominal pain in adulthood."


I know that these sources have said that mostly children get abdominal migraines, but adults do too. Here is a study of a thirty-two year old woman with abdominal migraines:

Source:https://www.researchgate.net/publication/236836632_Abdominal_Migraine_in_Adults_A_Review_of_Pharmacotherapeutic_Options_June




It seems like it would be very difficult to diagnose in Gastroparesis Warriors because a lot of us already suffer from the same symptoms that abdominal migraines cause. I have not found a lot in regards on how to tell if you have an abdominal migraine, only that it lasts up to seventy-two hours. I know migraines are different Gastroparesis (vagus nerve damage usually), but the vagus nerve does control your memory. I have written an article about it previously, if you want to see everything that the vagus nerve controls: http://www.emilysstomach.com/2016/07/information-about-vagus-nerve.html




Source: listed on the image




I just wonder if there is a correlation between a damaged vagus nerve and abdominal migraines? I have not found anything in my research that supports that except for what the vagus nerve controls. I will try to keep this article updated and try and find the answers to questions that I have about this condition.


Source: The Daily Mail

This person's story really touched me. I know that mostly children get abdominal migraines than adults do, now that I have read some studies and done some research. The doctors treat them the same way they treat Gastroparesis patients, like it is not real, or that we are faking. There are a million reasons we are not believed but her son's story touched my heart. You can read it here: http://www.dailymail.co.uk/health/article-1053613/Seizures-stomach-pains-If-think-symptom-migraine-headache-think-.html


Above is a chart of Abdominal Migraines but I also included another chart with different kinds of Migraines I have never heard of before. I hope this will help someone out there, struggling with these symptoms.


Source: on the image

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