Abstract:

Abdominal migraine is a functional gastrointestinal disorder predominantly seen in children, characterized by recurrent episodes of moderate to severe abdominal pain associated with migrainous features. Owing to its episodic nature and absence of definitive diagnostic tests, it is often underdiagnosed or misdiagnosed as recurrent abdominal pain.

Case Presentation:

We report a case of a 10-year-old female child who presented with recurrent episodes of severe, poorly localized abdominal pain associated with nausea and vomiting, each episode lasting several hours and resolving completely between attacks. There was no identifiable organic pathology on clinical evaluation and relevant investigations. A positive family history of migraine and fulfillment of Rome IV diagnostic criteria supported the diagnosis of abdominal migraine.

The child showed significant improvement with migraine prophylactic therapy and lifestyle modifications.

Discussion:

The prevalence of recurrent abdominal pain in children ranges from 9% to 15%,2  the estimated prevalence of abdominal migraine as a subset of this is within the range of 2.4% and 4.1%, is more common in those with a migraine family history, and rarely persists into adulthood.Up to 70% of children with abdominal migraine will develop more traditional migraine later in life, typically at 9 to 10 years of age.Abdominal migraine usually starts in childhood, though it may occur in adults, commonly with a family history of migraine.

Abdominal migraine is episodic central abdominal pain occurring with other features of migraine and associated with other episodic syndromes (particularly cyclical vomiting and migraine limb pain).Pain is dull, midline or periumbilical, and moderate to severe in intensity, lasting 2 to 72 hours if not treated. Headache is not a prominent feature; vasomotor symptoms, such as nausea, vomiting, pallor, and anorexia, are common. The person is well between episodes with a normal physical examination and developmental milestones.Abdominal migraine is a positive clinical diagnosis and requires no further investigation once “red flags” are excluded.

Diagnostic criteria:

Rome IV Criteria for diagnosing Functional Abdominal Pain Disorders (FAPD):

These are currently used in pediatric gastroenterology and are widely cited as the standard for functional abdominal migraine diagnosis:

Diagnostic pathway:

Investigations:

Management:

Management of abdominal migraine is primarily conservative.

• Non-pharmacological measures(first line of treatment and are effective in many children): reassurance, trigger avoidance, dietary modification, and cognitive behavioral therapy, forms the.
• Pharmacological prophylaxis (reserved for severe or refractory cases): agents extrapolated from migraine management

such as propranolol, cyproheptadine, pizotifen, and flunarizine;valproic acid and sumatriptan are the newer agents which have shown successful results.

Conclusion:

This case underscores the need to consider abdominal migraine in children presenting with recurrent abdominal pain. Early recognition based on established diagnostic criteria can prevent unnecessary investigations and enable timely, targeted management, leading to improved clinical outcomes and quality of life.

References:

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5. Symon DN, Russell Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Arch Dis Child. 1995;72:48–50.
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Dr. Vishaka,
First year ER PG
Kauvery Hospital, Chennai.