Abdominal Migraine

Migraine is not just a headache. It can be a hugely debilitating condition which can affect the whole body and result in many symptoms. As migraine in children and young people (abdominal migraine) can be very different to migraine in adults, it can be easy for the condition to go unrecognised. This can cause a huge amount of distress to young migraineurs and their families. When is it migraine? With headaches or abdominal pain which: Disrupt normal activities May be associated with other symptoms Occur in defined episodes Do not come and go during the attack and the child is completely normal between attacks.it is likely to be migraine. The difference between a headache and migraine Many children will experience occasional headaches with around 70% of schoolchildren having a headache at least once a year. In most cases this is an isolated occurrence and the cause of the headache is clear, such as a bump on the head or an infection, such as a common cold. Children with migraine often describe their headache as just sore rather than throbbing and in the middle of the forehead (rather than on the side of the head, as is commonly the case in adults). A migraine headache may also be accompanied by: Increased sensitivity to light, sound and / or smells Abdominal pain Aches, pains and excessive tiredness Dizziness Aura neurological symptoms such as visual disturbances, confusion, numbness or pins and needles Nausea and / or vomiting Although a severe headache is common in adults, it is less of a feature in children who may not experience a headache at all, or it may only be moderate and mentioned when questioned. If they have some of the symptoms listed above and follow a pattern of attacks, but are well in between, it is likely to be migraine and should be investigated by a GP.

Abdominal migraine In around 4% of young migraineurs the predominant symptom of the attack is abdominal pain rather than a headache. In these cases migraine can commonly go unrecognised or be incorrectly diagnosed (for example, it may be believed that the child gets lots of stomach bugs or infections). In around half of children with abdominal migraine the symptoms evolve into the more recognised migraine pattern as the child grows. The term migraine equivalents and variants are used to describe forms of migraine where headache is less prominent and other symptoms are more prominent. This includes abdominal migraine, cyclical vomiting syndrome (children with CVS experience regular episodes of intense nausea and vomiting with some requiring hospital admission due to dehydration) and benign paroxysmal vertigo (sudden and recurrent episodes of vertigo). What causes migraine? It is believed that all children and adults have the capacity to suffer from migraine, but that in 10-15% of the population there is an increased susceptibility a lower threshold at which an attack is triggered. It is believed that the release of serotonin (a natural chemical in the body) from its storage sites into the bloodstream causes changes to the neurotransmitters (chemical messengers) and blood vessels in the brain, causing a migraine. However, exactly what prompts these changes is still a subject for research and debate. There is also a genetic predisposition to migraine (if a parent suffers from migraine, a child has a 30% chance of being affected. If both parents are affected, the child has a 60% chance of being a migraineur themselves). Migraine triggers There may be certain circumstances when a child is more likely to have an attack these trigger factors are often very individual. For many there is not just one trigger but a combination of factors which individually can be tolerated, but when several occur together a threshold is past and an attack occurs. Common triggers in children can include dehydration, not eating regularly, irregular sleep patterns, stress and anxiety (or other heightened emotions, such as excitement), particular foods and drinks (can include too much caffeine, citrus fruits, chocolate or foods with lots of additives, but these are often individual to a particular child), too long spent watching TV or on the computer and, particularly for girls, puberty. Keeping a migraine diary (see diagnosing migraine section) can help to identify any attack patterns and possible triggers.

The five stages of an attack Although not all migraines follow the same pattern, there are generally considered to be five phases of a migraine attack: The prodrome (warning) stage: Signs, such as an unusual hunger or thirst or a loss of or excess energy, can sometimes be present up to 72 hours before the main stage of the attack. The aura: Around 20% of children with migraine will sometimes experience aura (neurological) symptoms. These usually take the form of visual disturbances, such as blurred vision, flashing lights, blind spots or zigzag patterns. Less common symptoms include pins and needles, weakness of a limb, confusion or speech difficulties. This part of the attack which can be very frightening, especially for young children - can last from 5-60 minutes and usually precedes the headache / abdominal pain by 20 30 minutes. The main stage of the attack: Headache or abdominal pain will be present along with other symptoms such as nausea and / or vomiting. Children will be unable to continue with their usual activities and may want to rest in a darkened room or sleep. Resolution / postdrome stage: The pain gradually eases or may disappear after sleep; if a child vomits this also often eases an attack. Recovery stage: It can take 48 hours for a child to feel completely well after an attack. For others, recovery can be surprisingly quick. Diagnosing migraine There is no test for migraine so diagnosis by a GP or other healthcare professional will be based on taking a history and looking at the symptoms and pattern of attacks. The use of a migraine diary to record these can be vital in aiding diagnosis. Migraine Action has diary sheets available for this purpose which allow you to record dates, attack severity, symptoms, and think about the foods and drinks which were consumed and the activities which took place prior to an attack. Migraine management and treatment There is not yet a cure for migraine but often lifestyle management can make a big difference to the frequency of attacks and medications are available to help those children who are more severely affected.

Key lifestyle tips for children Drink at least two litres of water a day Eat regularly and healthily Keep regular sleep patterns Make time for rest and relaxation Get some exercise (with enough fuel (food) to support this) and fresh air each day Don t spend longer than 45 minutes watching TV, on the computer or on video games without a break (and not longer than 3 hours a day) These simple things, along with avoiding any known personal triggers can make a huge difference. Often children will not require medication and during an attack rest and / or sleep can be enough to end the attack for many. For those needing medication to ease the pain and discomfort during an attack there are many acute treatment options available. These range from over the counter medications, including Ibuprofen and paracetamol, to specific medications which can be prescribed by a doctor. Triptans are a group of drugs developed to treat migraine in adults. There is one triptan currently licensed for use in children from the age of 12 years. There are also preventative treatment options available for children who are severely affected, and these aim to help reduce the frequency and / or severity of attacks. There is more detailed information on treatment options in Migraine Action s booklet for parents and carers; please use the order at the back of this booklet if you would like a copy. Some young migraineurs can also benefit from complementary therapies, such as acupuncture, cranial osteopath or homeopathy. Other types of headache Children, like adults, can also get other types of headache. These include: Tension type headache there are no other associated symptoms and the headache is often described as a tightness or pressure around the head. It is better to treat the cause rather than the symptoms of this type of headache. Substance induced headache taking regular painkillers can become the problem for frequent headaches rather than the cause and is risked if painkillers are taken on two or more days a week. An intake of large amounts of other substances (such as caffeine) can also cause headaches in a similar way. Chronic daily headache - this is believed to affect around 1% of children and is when the child has a headache on more than 15 days a month. This can be caused by a head or neck injury or medication overuse. Cluster headache is quite rare in children, with attacks occuring in clusters of up to eight times a day for a cluster period, often between 6-8 weeks. The pain is often excruciating.

Primary and secondary headaches Migraine is a primary form of headache. Secondary headaches are referred to as such when the pain is caused by a more serious underlying condition. Some signs that suggest a headache is secondary and should be investigated by a GP include: Sudden severe headaches with no other symptoms especially if a child has received a blow to the head. A change in the symptoms or pattern of attacks has occurred. Headaches are constant they do not come and go in between attacks (as is the pattern with migraine). It occurs with fever, neurological problems or fits. Progression of symptoms getting worse all the time. Facts about migraine in children and young people 10% of school children suffer from migraine. 2.75 million school days are missed each year due to migraine. A migraine attack in children may last for as little as an hour but can be as long as three days and they are symptom free between attacks. The frequency of attacks varies between 2-3 attacks per year and 2-3 attacks per week, but the average is one per month. Around half of all migraineurs will have had their first attack by the age of 12 years. Migraine has been reported in infants as young as four months; in these cases it has been recognised by the sudden, short-lived paralysis of eye muscles, face or one of the limbs, which draws attention to the onset of an attack. Migraine occurs equally in both sexes up to the age of 12 years, after which it becomes more common in girls as they often experience their first attack around puberty. 20% of children with migraine can experience aura symptoms. It is a common misconception that aura symptoms are a prerequisite for a diagnosis of migraine. This is untrue; migraine without aura is more common. In at least 4% of children, the predominant symptom of migraine is recurrent abdominal pain, possibly without headache, or the headache is mild. In the absence of headache the condition may easily go unrecognised. 90% of children with migraine will feel nauseous and 60% will vomit. Migraine is triggered by a huge variety of factors not just cheese and chocolate. A common trigger in children and young people is dehydration. There is a genetic predisposition to migraine so a family history of the condition can aid diagnosis. However, this is not always the case. If migraine is suspected, the diagnosis should be confirmed by a GP. Although there is not yet a cure for migraine there are many lifestyle management and treatment options available.

Young migraineurs resources order form Title of information resources Migraine in children and young people - full information pack for parents / carers (contains booklet, migraine diary sheets, migraine ACTION! card, plan of action sheets, GP template letters etc.) Migraine in children and young people - an information booklet for parents / carers Migraine plan of action sheets (pack of 5) Migraine diary sheets for young migraineurs (pack of 5) Migraine ACTION! card and factsheet GP template letter to schools GP template letter to exam board Young migraineurs Adventure pack - for ages 8-10 years (contains booklet, game, diary sheets, plan of action sheets etc.) Young migraineurs Explorers pack - for ages 11-13 years (contains booklet, game, diary sheets, plan of action sheets etc.) Young migraineurs Network pack - for ages 14-17 years (contains booklet, diary sheets, plan of action sheets etc.) Children get migraine too awareness poster Teachers information pack School nurses information pack Joiners form for young migraineurs club Join Migraine Action - details on adult and family membership Fundraising for Migraine Action leaflet Copies of this booklet - Migraine in children and young people Quantities Would you like to receive your information resources by email or post? I would like to receive my information resources by email and help cut Migraine Action s costs (please tick and insert email address in the box): I would like to receive my information resources by post (please tick and fill out your address details in the section below): First name: Surname: Address: Town: County: Postcode: Telephone:

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