Some kids' belly pain could be a migraine

NEW YORK (Reuters Health) - If your child suffers from mysterious abdominal pain, it may be a variety of migraine, according to a new study.

“There are lots of kids that have recurring unexplained abdominal pain, and when a kid is continually having these bouts of pain, sometimes there’s no obvious cause found,” said Dr. Donald Lewis from the division of pediatric neurology at the Children’s Hospital of the King’s Daughters in Norfolk, Virginia.

One cause rarely considered is an abdominal migraine, Lewis, who co-authored the study, told Reuters Health. It affects about two out of 100 kids, and is usually treated with painkillers and diet, he said.

Abdominal migraine is a common diagnosis in Europe and the U.K., but it’s not made in the U.S. very often, Lewis told Reuters Health. “A lot of health care providers don’t know this exists.”

About nine to 15 out of 100 kids and teens have chronic abdominal pain, according to the American Academy of Pediatrics.

The researchers reviewed the medical charts of more than 450 such kids and teens who went to the gastroenterology clinic at the Children’s Hospital of the King’s Daughters with recurrent abdominal pain. They checked the kids’ symptoms against a list of criteria for abdominal migraine.

These include at least five attacks of abdominal pain that last at least an hour, pain the middle of the belly, nausea, vomiting, and paleness. Attacks can last up to 72 hours.

About four out of 100 kids met the criteria for abdominal migraine. Another 11 out of 100 missed just one of the criteria and were labeled “probable” abdominal migraine.

This is 15 out of 100 kids that have chronic belly pain, but it’s not insignificant, Lewis said. “We’re not dealing with a rare disease.”

What causes even the more familiar migraine headache is poorly understood. The leading theory is that abnormal cell activity along certain brain pathways triggers pain and blood vessel changes in the head.

An abdominal migraine is the same thing as a migraine in the head, but instead it’s felt in the stomach, Lewis said. Kids generally outgrow them, but many do go on to have migraine headaches as adults.

The study was published in the journal Headache.

Of the kids that met the formal criteria for abdominal migraine, six out of ten had family members that suffered from migraines.

Many parents of kids with abdominal migraines assume the condition is serious, because the kids “look ghastly pale, usually,” said Dr. George Russell, a retired professor of child health at the University of Aberdeen in Scotland.

“It’s no more life-threatening than a migraine, but equally unpleasant and uncomfortable,” Russell, who did not work on the study, told Reuters Health.

He generally advised kids to avoid foods that typically trigger migraines, many in the ‘foods that start with c’ category: cheese, chocolate, caffeine, citrus fruits, and Chinese food, among others.

“It’s also helpful to take the attack seriously, and to try to sleep it off,” Russell said.

Acute attacks can also be treated with antacids or painkillers, Lewis said. “But if kids have recurrent attacks, there is a group of medications that they can take daily to keep these attacks from coming,” he said.

These include cyproheptadine (Periactin), topiramate (Topamax), and amitriptyline (Vanatrip, Elavil, or Endep). The FDA currently has warnings out on the increased risk of suicidal thoughts in kids and teens on antidepressants such as amitriptyline, and the drug is not recommended for patients younger than 12.

Abdominal migraines have been known in the U.K. for years, Russell said, and “it’s very nice to see the Americans waking up to it.”

“Hopefully, this will alert people who take care of kids that maybe the reason that the fifteenth antacid hasn’t worked is that it might be something else,” Lewis said.

SOURCE: Headache, online March 11, 2011.