Q: My niece's 3-year-old twin son suffers from abdominal migraines. His twin sister does not get them. There doesn't seem to be a pattern as to when he'll get sick. My niece says my mother suffered from migraines when she was living. Can you tell me more about these migraines? Are they hereditary? --- J.N., Kennesaw
A: Most of my readers would be surprised to learn that there's a type of migraine generally seen in young children that doesn't cause a headache, or even involve the head. This uncommon "headless" migraine event is called an abdominal migraine.
It's a difficult diagnosis to make because its symptoms --- dull abdominal pain around the belly button region, nausea, vomiting, loss of appetite and occasional facial flushing --- are often attributed to other things.
About 10 percent of healthy school-age kids will at some time experience recurrent episodes of abdominal pain. In only 10 percent of those kids is a medical problem actually found. Because of the difficulty in making the diagnosis, some with unexplained pain may have undiagnosed abdominal migraines.
Abdominal migraines peak between the ages of 5 and 9, although they can persist into adulthood. Fortunately, they do tend to subside into adulthood. These children are also at higher risk for traditional migraine headaches. And like traditional migraines, these do tend to run in families.
The diagnosis of abdominal migraine is made only after other medical conditions like an ulcer, gastritis, lactose intolerance, intestinal blockage, inflammatory bowel disease and irritable bowel syndrome have been ruled out through bloodwork, urinalysis, endoscopy and/or imaging tests.
It's also important to inquire about family/school stressors, diet and bowel habits.
This is a migraine event that happens just like those in the head: There's an initial constriction of the blood vessels that supply the abdomen (hence the pain), followed by dilation of those blood vessels (the cause for occasional flushing).
Once the cause of the pain is identified as an abdominal migraine, the treatments are much the same as in other forms of migraines. In children, sleep is particularly effective.
A pediatric neurologist is best qualified to prescribe preventive and abortive treatments.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," P.O. Box 767787, Roswell, GA30076. Because of the large volume of mail received, personal replies are not possible.
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