What is an abdominal migraine?
Migraine headache is a neurological disorder that involves both headache pain, which can be severe, and other neurological or systemic symptoms (Dodick 2018, Irwin 2017). These symptoms can include sensitivity to light or sound (photophobia and phonophobia) and even touch, or the feeling of low mood or psychological distress. Other symptoms can involve the gut (Aurora 2021, Kim 2022), including nausea and even vomiting.
Abdominal migraines are basically the same as migraine headaches, except that the pain is in the gut, usually epigastric (around the stomach; upper left quadrant) or peri-umbilical (midline, belly button area). The pain is usually described “dull” or “just sore” (Irwin 2017) and can range from moderate in intensity to debilitating. These episodes can last from hours to days, but in between episodes, people are symptom-free (Angus-Leppan 2018, Irwin 2017, Rome Foundation 2021) and otherwise healthy.
Who is at risk for abdominal migraines?
Abdominal migraines were first recognized in children, and the Rome IV criteria for diagnosis of Functional Bowel Disorders/Disorders of Brain-Gut Interaction only lists it under Childhood Functional GI Disorders: Child/Adolescent (Rome Foundation 2021). Thus, abdominal migraine is usually considered a pediatric disorder. However, cases of abdominal migraines have been identified recently, although more rarely, in adults (Woodruff 2013). It is possible that abdominal migraines are in fact more common, but are underdiagnosed based on the assumption that it is a pediatric condition.
Among both children and adults, history of migraine headaches is common (up to 70%; Irwin 2017, Angus-Leppan 2018) and migraine headaches run strongly in families. Thus, abdominal migraines seem to follow from a genetic susceptibility. It is slightly more common in females (Angus-Leppan 2018).
What triggers an attack of abdominal migraine?
Triggers for abdominal migraine are similar to migraine headaches. These include stress, sleep loss, travel, or missed meals (Angus-Leppan 2018). Sometimes people report bright light or low moods as being triggers of abdominal migraine, but these are believed to represent early phases of the attack, rather than actual triggers (Angus-Leppan).
Why do we think abdominal migraines are related to migraine headaches?
There are lots of reasons! One is related to the close link of gut symptoms with migraine (Aurora 2021, Kim 2022), high rate of co-morbidity, and of intimate relationship of the gut and brain, especially where stress and pain are concerned. The overlap of symptoms, such as pain, photophobia, mood problems between both conditions argues for a similar pathophysiology. Both conditions are complex, with genetic, neurological, vascular, and immune/inflammatory contribution to the generation of symptoms. Although there is not much research specifically on pharmacological treatment for abdominal migraine, medications used for migraine headaches, including sumatriptan (for acute treatment) and pizotifen and topimirate (for prevention), have been reported to help abdominal migraines as well (Agnes-Leppan 2018, Woodruff 2013).
Gut Advice
- Keep to regular sleep and meal schedules. The most common factors cited as triggers for abdominal migraine are disruptions in behavioral rhythms (Angus-Leppan 2018) as noted above. These rhythms are key to regulating endocrine, metabolic and immune functions that keep our brains and guts working properly (Focke 2020, Wehrens 2017). As such sleep loss and missing meals can serve as stressors that dysregulate systems, such as the cortisol system, that in turn can regulate function of pain neurons.
- All of the Disorders of Brain-Gut Interactions are sensitive to psychological stress, and psychological stress can enhance pain, via visceral hypersensitivity. Visceral hypersensitivity means that pain neurons that innervate the gut become sensitized and dysregulated, such that their thresholds to signaling pain are reduced (Creekmore 2018, Vermeulin 2014). For these reasons it is important to address potential stressors. Cognitive behavioral therapy has been shown to be helpful for related disorders (Angus-Leppan 2018) as have relaxation-based mind-body therapies (Shah 2020).
- Disorders of Gut-Brain Interactions are complex, both to diagnose and to treat. An accurate diagnosis is important (Angus-Leppan 2018) because diagnoses of “medically unexplained” or “psychogenic” pain can actually worsen pain in both children and adults. Although it is tempting to try elimination diets for abdominal migraines, there efficacy is not supported (Angus-Leppan 2018) and they could actually make things worse.
References
Angus-Leppan H, Saatci D, Sutcliffe A, Guiloff RJ. Clinical Updates Abdominal migraine. BMJ, 360:k179, 2018
Aurora SK, Shrewsbury SB, Ray S, Hindiyeh N, Nguyen L. A link between gastrointestinal disorders and migraine: Insights into the gut-brain connection. Headache, 61:576-589, 2021
Creekmore AL, Hong S, Zhu S, Xue J. Wiley JW. Chronic stress-induced visceral hyperalgesia correlates with severity of intestinal barrier function. Pain, 159:1777-1789, 2018
Dodick DW. Migraine. Lancet, 391:1315-1330, 2018
Focke CMB, Iremonger KJ. Rhythmicity matters: Circadian and ultradian patterns of HPA axis activity. Molecular and Cellular Endocrinology,501”110652, 2020
Irwin S, Barmherzig R, Gelfand. Recurrent gastrointestinal disturbance: abdominal migraine and cyclic vomiting disorder. Current Neurology and Neuroscience Reports, 17:21, 2017
Kim J, Lee S, Rhew K. Association between gastrointestinal diseases and migraine. International Journal of Environmental Research and Public health. 19:4018, 2022
Lenglar L, Caula C, Moulding T, Lyles A, Wohrer D, Titomanlio L. Brain to belly: Abdominal variants of migraine and functional abdominal pain disorders associated with migraine. Journal of Neurogastronenterology and Motility, 27:482-494, 2021
Rome Foundation, Rome IV Criteria, theromefoundation.org/rome-iv/rome-iv-criteria/, 2021
Shah K, Ramos-Garcia M, Bhavsar J, Lehrer P. Mind-body treatments of irritable bowel syndrome symptoms: An updated meta-analysis. Behavior Research and Therapy, 128: 103462, 2020
Vermeulin W, De Man JG, Pelckmans PA, De Winter BY. Neuroanatomy of lower gastrointestinal pain disorders. World Journal of Gastroenterology, 20:1005-1020, 2014
Wehrens SMT, Christou S, Isherwood C, Middleton B, Gibbs M, Archers SN, Skene D, Johnston JD. Meal timing regulates the human circadian system. Current Biology, 27:1768-1775, 2017
Woodruff AE, Cieri N, Abeles J, Seyse SJ. Abdominal migraine in adults; A review of pharmacotherapeutic options. Annals of Pharmacotherapy, 47:e27, 2013