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Pediatric Functional Gastrointestinal Disorders
Published in John F. Pohl, Christopher Jolley, Daniel Gelfond, Pediatric Gastroenterology, 2014
On the contrary, the classification of abdominal migraine includes a more specific clinical symptom pattern. Abdominal migraines are characterized by intense, discrete episodes of periumbilical pain, lasting at least 1 hour and with associated features (two or more) of anorexia, nausea, vomiting, headache, photophobia, or pallor. The pain is severe enough to interfere with the child’s activities and characterized by intervening periods of normal health. Childhood FAP represents those patients who do not meet the criteria for any other pain-predominant FGID. It is defined as continuous or episodic abdominal pain, not explained by an organic process or another FGID, and occurring at least once per week for a minimum of 2 months.
Chronic abdominal, groin, and perineal pain of visceral origin
Published in Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen, Clinical Pain Management, 2008
Abdominal pain may also result from nonabdominal sites. Abdominal migraine is a variant of the more typical migraine. Rather than headache and nausea, symptomatology may consist of abdominal pain and nausea. Treatment is similar to that of other migraines.
Global prevalence and international perspective of paediatric gastrointestinal disorders
Published in Clarissa Martin, Terence Dovey, Angela Southall, Clarissa Martin, Paediatric Gastrointestinal Disorders, 2019
Shaman Rajindrajith, Niranga Devanarayana, Marc Benninga
Abdominal migraine is a well-known cause for abdominal pain in children. In the current Rome III criteria, it is recognised as paroxysmal episodes of intense peri-umbilical pain lasting for more than 1 hour with associated symptoms such as nausea, anorexia, vomiting, headache, photophobia and pallor. Affected children are otherwise well between attacks and the period between episodes may last for weeks to months (Rasquin et al., 2006). Abdominal migraine has been recognised as a common cause of recurrent abdominal pain in children in several hospital-based studies using Rome II or Rome III criteria (Devanarayana et al., 2011a; Helgeland et al., 2009; Walker et al., 2004). In a study using the International Classification of Headache Disorders, 4.4% children evaluated for abdominal pain had abdominal migraine (Carson et al., 2011). An epidemiological survey conducted in the United Kingdom, using International Headache Society criteria, noted 4.1% of children as having abdominal migraine (Abu-Arafeh and Russell, 1995b). In this study, the prevalence of abdominal migraine was higher among girls and attacks were associated with exposure to stressful events, travel, tiredness and consumption of certain food items. In a Sri Lankan school-based survey involving children aged 10–16 years, it was found that only 1% of children suffered from abdominal migraine according to the accepted criteria (Devanarayana et al., 2011a). It was also noted that this disorder is associated with family- and school-related psychological stress. Other painful conditions such as headache and limb pains, photophobia, light-headedness and sleeping difficulties were commonly associated with abdominal migraine. In addition, other functional abdominal symptoms such as bloating, loss of appetite, flatulence, burping, nausea and vomiting were also associated with abdominal migraine (Devanarayana et al., 2011b).
Recent advances in the management of chronic migraine in children
Published in Expert Review of Neurotherapeutics, 2018
Marco Antônio Arruda, Camila Flaksberg Chevis, Marcelo Eduardo Bigal
Migraine in children and adolescents is a multi-faceted condition with striking peculiarities such as the very short duration of the attacks in young children, the associated periodic syndromes (e.g. cyclical vomiting and abdominal migraine), and the expressive high placebo effect. Nearly 55% of children receiving placebo prophylaxis achieve the primary endpoint and the rate approaches 70% with acute therapy, compared to adult rates that are close to 35% and 45%, respectively. Factors inputted to explain the high placebo rate in children include regression to the mean (short duration of attacks), inadequate study designs, and beliefs and perceptions that are inherent to the age group [42]. These aspects must be kept in mind when analyzing the few available studies on the treatment of CM in pediatric age. Another important point is that ‘no evidence of efficacy does not mean the evidence of no efficacy’ [42]. Many of the medication used for CM prophylaxis in children and adolescents, such as amitriptyline, flunarizine (not available in USA), topiramate and divalproex, are routinely prescribed off label, and they seem to be efficient and safe. Are they effective or are clinicians observing the placebo effect? Anyway, does it matter? ‘Although placebo is the enemy of great trials, it is likely the best friend of good clinicians’ [42]. The lack of evidence should not immobilize the clinicians treating a child suffering from CM and its associated burden.
Dysautonomia in the pathogenesis of migraine
Published in Expert Review of Neurotherapeutics, 2018
Parisa Gazerani, Brian Edwin Cairns
Research conducted on migraine has been focused, understandably, on the mechanisms of pain generation in this condition, with significantly less progress made on understanding the role of the ANS in its pathogenesis. As discussed, migraine is a phasic disorder with a variety of clinical features that include a number of symptoms that result from altered autonomic tone. In some cases, ANS dysfunction appears to be a risk factor for the development of migraine. For example, there are conditions associated with migraine development that, at least in their early stages, do not involve headache but do involve alteration in autonomic tone. Abdominal migraine is a childhood condition thought to transform to migraine in many sufferers as they age. Abdominal migraine is characterized by abdominal pain, pallor, nausea, and vomiting, and while it has similar triggers as migraine, sufferers do not experience headaches. As discussed, migraineurs often present with gastroparesis during attacks. Whether this is a cause or consequence of the migraine attack has not really been investigated, however, gastroparesis is associated with abdominal pain, nausea, and vomiting. The obvious similarity in symptoms between abdominal migraine and migraine, and the transformation from abdominal migraine to migraine are suggestive of a common mechanism for both conditions that may involve a dysfunction of the ANS.
An overview of the clinical management of cyclic vomiting syndrome in childhood
Published in Current Medical Research and Opinion, 2018
Claudio Romano, Valeria Dipasquale, Anna Rybak, Donatella Comito, Osvaldo Borrelli
The NASPGHAN consensus admitted the strong link which had been postulated between CVS and migraine6. The potential association between CVS and migraine was first described by Whitney in 189819. Symon and Russell20 showed that up to 40% of children suffering from CVS developed migraine headaches later on in life. Abdominal pain is present in 80% of patients with CVS and may be periumbilical or epigastric and severe in course21. If abdominal pain is the predominant symptom, abdominal migraine, an alternative childhood periodic syndrome, should be considered. In the third ICHD, abdominal migraine is defined as an idiopathic disorder that may be associated with migraine without underlying gastrointestinal organic diseases17. Abdominal migraine is characterized by recurrent, acute-onset abdominal pain and associated with dysautonomic symptoms and signs, such as pallor, anorexia, nausea, vomiting, dark shadows under the eyes and flushing22,23. In contrast to CVS, vomiting in abdominal migraine is a less prominent feature. Occasionally, pain is preceded by nonspecific symptoms, such as anorexia (14%)23. Attacks last between 2 hours and 72 hours and are usually interspersed with symptom-free periods. Abdominal migraine usually occurs at 7 years of age, with peaks at ages 5–7 and 10–12, and prevalence ranges between 1% and 23%, based upon the diagnostic criteria used16,23. Girls are more likely to be affected than boys (female to male ratio of 3:2). Due to similarities in both epidemiologic and demographic features, both abdominal migraine and CVS are currently considered childhood variants (or equivalents) to migraine, and common pathogenesis and trigger events are suspected2,22,23.