Abdominal Migraine headache symptoms

The symptoms of migraine change with ageing and even though migraine usually starts in the second decade of life (between 11 and 20 years old) the symptoms when younger for some patients are more gastrointestinal or vasomotor than neurological.  That is, the patient may have more nausea, vomiting, stomach cramping, vague abdominal pain, or loss of appetite.  Since women get migraine three times more than men, the patient here is usually a young girl.  Then later, usually in her young twenties the GI symptoms and mild headache turns into more typical migraine associated with nausea and vomiting.

Migraine affects the autonomic nervous system which controls arterial tone, gastric acid secretion, and GI motility.  Abdominal migraine is what is called a “migraine equivalent.”  The syndrome of abdominal migraine consists of recurrent attacks of midline abdominal pain which is “dull” or “sore” and which lasts 1-72 hours.  The pain is moderate or severe intensity and associated with nausea and vomiting.  Headache is absent or not very prominent at this age.  The attacks come in episodes and the patient is symptom free between attacks.  To fulfill diagnostic criteria there must at least 5 attacks and during the abdominal pain 2 of the following vasomotor symptoms should occur:  anorexia, nausea, vomiting, or pallor.

Treatment is the usual migraine lifestyle and using any of the common migraine preventive drugs--propranalol, topamax, or amitriptyline.  Nausea and vomiting are treated with Phenergan (promethazine) 25 mg po every 4-6 hours prn or Zofran (odansetran) odt 4mg po every 8 hours prn.

Young migraine patients outgrow abdominal migraine and then develop typical migraine.