Abdominal migraine in children-An underdiagnosed entity

Abdominal migraine is one of the causes for chronic and recurrent abdominal pains, characterised by recurrent episodes and paroxysms of moderate to severe abdominal pain. Here, we share a case of recurrent severe abdominal pain in a 9-year-old girl who was treated over a period of three months for giardiasis, chronic appendicitis and H. pylori infection, in that order. However, after she was correctly diagnosed with abdominal migraine and accordingly treated with drugs used for the treatment of migraine headaches such as propranolol, flunarizine, cyproheptadine and ergotamine tartrate, she responded well to this regimen.

Adult Abdominal Migraine Improved by OnabotulinumtoxinA Injections

Abdominal migraine is often regarded as a childhood disorder and less commonly described in adults. However, gastrointestinal symptoms are known to occur to adult migraine patients, and recognition of adult abdominal migraine may facilitate treatment of the recurrent abdominal symptoms and avoidance of unproductive and sometimes invasive therapies. Here, I describe a patient with chronic migraine headaches and recurrent abdominal pain both of which showed sustained improvement after treatment with onabotulinumtoxinA injections.

Abdominal migraine in a pediatric patient

Abdominal migraine (AM) is a syndrome usually diagnosed in childhood. The AM syndrome comprises episodic attacks of severe, recurrent, and chronic abdominal pain localized in the periumbilical area, followed by symptoms like headache, anorexia, nausea, vomiting, or pallor. Between the abdominal migraine episodes the child felt good and continued to develop well. The pathophysiological process is presumed to be similar to that of other functional gastrointestinal disorders (FGIDs) and cephalic migraine. It is vital to assess anamnesis, dietary and social history, detailed physical examination, and symptom-based guidelines. Evaluation of the patient for the presence of any potential alarming symptoms or signs, to exclude an organic disease, is essential. The major problem is the lack of knowledge regarding its unclear pathophysiology. Nonpharmacological and pharmacological treatment alternatives vary. Although thorough diagnostic criteria under Rome IV classification of FGIDs and International Classification of Headache Disorders are available, AM persists to be an underdiagnosed entity. A definite diagnosis of abdominal migraine allows appropriate management and avoids unnecessary investigations and incorrect treatments.