migraine most typically occurs in children, although it has been reported in
adults. Patients usually complain of paroxysmal midabdominal pain lasting form
1-72 hours, associated with nausea and vomiting, flushing, or pallor. Like
cyclic vomiting, attacks may be associated with other migraine prodromes such
as fatigue and drowsiness. Aura and headaches are frequently absent or minimal.
Patients may develop migraine late in their life, and family history of
migraine is common. Gastroenterologic evaluation and workup is unremarkable.It
is more common in females as with other types of migrane. Children with abdominal
migraine or cyclic vomiting may show subtle clumsiness, attention deficit, or
development delay. Abdominal migraine symptoms
are usually relieved with sleep. Antiemetics may help aborting an acute attack.
For chronic prevention, low doses of tricyclic antidepressants and flunarizine,
a calcium channel blocker, are effective. Other migraine prevention medications
are occasionally of some benefit.