Abdominal Migraine

7 y/o pt with presents with acute on chronic abdominal pain. Pain can be diffuse or periumbilical with episodes lasting 2 to 72 hours and affecting normal activities. Reports associated unilateral H/A, photophobia, N/V, anorexia that worsen with stress, physical activity. Denies presence of blood in stool. Afebrile with pallor on exam.

• Consider CBC, U/A, beta-hCG, FOBT

• Initial treatment

  • Start Tylenol, ibuprofen for pain

  • Zofran for nausea

• Persistent symptoms

  • Consider propranolol and cyproheptadine for prophylaxis

  • 12+ y/o: Consider sumatriptan for acute pain

• Counseling

  • Parents advised to validate symptoms but avoid reinforcing symptoms with secondary gain, e.g. missing school

  • Family counseled about appropriate sleep habits, hydration

  • Family informed that symptoms generally dissipate in early adolescence

Note: Responsible for 5-15% of chronic abdominal pain in children