Revision 6 for 'Abdominal migraine'

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Abdominal migraine

Abdominal migraine (AM) is a syndrome which presents as recurrent episodes of severe abdominal pain, coupled with vasomotor symptoms, nausea and emesis. Historically it has tended to be a pediatric diagnosis, but is now increasingly seen in adults. It is one of the functional gastrointestinal disorders (FGIDs) 1. Similar to the other FGIDs its pathogenesis remains unresolved despite extensive ongoing work.

Epidemiology

Several research studies have established a range in prevalence from 0.4-4% 1. Studies suggest that the majority of children affected do not experience the condition into adulthood.

Clinical presentation

Diagnostic criteria

Diagnosis employs both the International Classification of Headache Disorders diagnostic criteria and Rome criteria.

Rome Criteria 1

Establishing the diagnosis requires at least two discrete episodes in a one-year period.

These episodes must consist of:

  1. paroxysmal episodes of intense, acute periumbilical pain that lasts for one hour or more
  2. intervening periods of usual health lasting weeks to months
  3. pain interferes with normal activities
  4. pain is associated with two of the following:
    • anorexia
    • nausea
    • vomiting
    • headache
    • photophobia
    • pallor
  5. No evidence of an inflammatory, anatomic, metabolic, or neoplastic process considered that explains the subject’s symptoms

No specific pathological diagnostic markers exist.

Radiographic features

By definition (see above) all imaging of the GI system should be unremarkable. 

Treatment and prognosis

An ideal management framework remains to be established. Nevertheless the key initial step is to exclude serious underlying organic disease e.g. inflammatory bowel disease and malignancy. 

Symptomatic therapy, e.g. analgesics and antiemetics is useful.

The long term prognosis of abdominal migraine remains undetermined, however it is clear that affected children have an increased risk of developing 'classic' migrainous headaches.

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