A 12 year old girl presents with a several month history of daily episodes of abdominal pain with some diarrhea (loose bowel movements). Her bowel movements were 3-4 per day without nocturnal defecation. She had no weight loss and her growth and Tanner development were normal compared to an older sister. She has complained of daily headaches without aura since age 8. She also gave a history of motion sickness, especially in automobiles. On physical examination her vital signs were normal and there were no abnormalities in the physical examination. A therapeutic trial was initiated.
Answer and Discussion
This young person had abdominal migraine. She responded to Inderal 10 mg by mouth thrice daily. Not only did her abdominal pains find relief but she no longer complained of headaches. Ninety percent of recurrent abdominal pain in pediatrics is functional, the farther from the umbilicus, the greater the chance for significant disease. The differential diagnosis includes cyclic vomiting, tachygastria, and, perhaps, abdominal epilepsy. Abdominal migraine is said to affect 2-4 % of children, 60 % are female, with the age of onset between 2 and 10 years. The pain is associated with other complaints, such as anorexia, nausea, vomiting, and pallor. Sixty percent of children are said to have a family history of migraines. Most children outgrow their abdominal pains but they may develop or continue to have migraine headaches. Propanolol and cyproheptadine have been described as beneficial in preventing these episodes. During the acute episode some find that acetaminophen or ibuprofen may be helpful; anti-nausea medications such as triptans are best administered rectally; intravenous valproic acid has been reported to be successful in the Emergency Department.