Abdominal migraine is the paroksizmalny idiopathic frustration which is characterized by pain episodes in the central part of a stomach lasting 1-72 hours. The painful attack is followed by the dispepsichesky, vasomotorial phenomena. Abdominal migraine is diagnosed on the basis of clinical symptomatology after an exception of possible causal pathology from bodies of a GIT, kidneys, a brain. Treatment means the actions directed to knocking over of an abdominalgiya (NPVS, the combined analgetics, triptana, antiemetic), and therapy during the mezhparoksizmalny period (preventive drug treatment, observance of the mode, an exception of triggers).
The term "abdominal migraine" (AM) is used in neurology since 1921. As this pathology occurs mainly at children and teenagers, before it carried to periodic syndromes of children's age. It became clear later that similar states can be found in adult patients. According to the International classification of a headache of 2013, abdominal migraine belongs to "Incidental syndromes which can be combined with migraine". According to various data, migraine of abdominal character is observed at 2-4% of children. In most cases the debut of a disease is the share of age of 2-10 years, peak of clinical manifestations — for 10-12 years. The ratio of sick girls and boys up to 20 years makes 3:2, at advanced age of the woman are ill twice more often than men. 70% of children with AM have further attacks of a classical migrenozny tsefalgiya.
Reasons of abdominal migraine
The exact reasons are not established, the multifactorial etiology is supposed. Numerous observations of patients with AM showed an important role of psychological aspects: features of character of the child and the parents who developed in a family of relationship. The uneasy, irritable children having hypersensibility to pain, discomfort are inclined to a disease. The situation is aggravated by unstable mentality of parents (especially mothers) – in families of children with AM the risk of maternal neurosises is high. 65% of the diseased have the parents having migraine that demonstrates existence of hereditary tendency. Generalizing the obtained data, many researchers consider that abdominal migraine arises at influence of psychological factors against the background of genetically determined predisposition.
As the triggers provoking a migrenozny paroxysm various psychoemotional loadings most often act: strong negative or positive emotions, psychological tension during the performance, passing an examination, etc. Meteosensitivity is possible. The dream deprivation, physical overfatigue, feeling of hunger also provoke an attack. At a number of patients abdominal migraine is connected with the use of certain products (fat grades of fish, chocolate, nuts) which exception leads to reduction of frequency of episodes of abdominal pain.
The mechanism of emergence of AM is not installed, the morphological substratum of a disease is absent. Violations have functional character, are connected with existence of the direct interactions between TsNS and digestive tract caused by their development from one embryonic fabrics. One of the main pathogenetic hypotheses assumes the following mechanism of development of an abdominal paroxysm: the stress increases activation of TsNS, there is an increased allocation of neuropeptids and neurotransmitters, the nervous, vegetative, vascular disregulyation of a GIT is a consequence of what. According to researchers, violation of adequate regulation results in hypersensitivity of intestinal receptors because of which usual stretching of intestines provokes a giperimpulsation in a spinal cord and further on the ascending ways to cerebral structures. The subsequent emergence of paroxysms is caused by preservation of trace memory with fixing of the pathological mechanism of emergence of pain at the level of a brain.
Symptoms of abdominal migraine
Migraine is characterized by tranzitorny paroxysms of belly-ache, the alternating asymptomatic intervals lasting several weeks or months. Abdominal pain of the moderated or expressed intensity is localized in okolopupochny area, in 16% of cases has diffusion character. Pain in a stomach is characterized by most of patients as stupid. The pain syndrome proceeds with anorexia, nausea, vomiting, diarrhea. Pain adversely affects ability of the child of a message usual activity. The behavior of the patient depends on age: younger children are capricious, ask on hands, seniors prefer to lie, cannot attend school. Vasomotorial reactions are typical: pallor of integuments (in 5% of cases — hyperaemia), a cold snap of extremities.
In 75% of cases abdominal migraine is noted in the morning. Sometimes its emergence is preceded by the prodromalny phenomena in the form of anorexia, changes of behavior or mood. Duration of an attack varies from 1 hour to 3 days, averages 17 hours. Disappearance of pain in the period of a dream is characteristic. Frequency of paroxysms within a year fluctuates from 2 to 200. At most of patients abdominal migraine is observed monthly, average annual number of attacks — 14. Over time the quantity of the tsefalgichesky migrenozny paroxysms arising during the period between attacks of an abdominal form or along with it increases.
Abdominal migraine with a big frequency of attacks complicates visit of children's collectives by the child of preschool age, causes the admission of lessons at school students. The pain syndrome negatively influences children's mentality, is dangerous by formation of an adynamy, neurasthenia, depressive, ipokhondrichesky qualities of character. Serious complications are caused by wrong primary diagnostics of AM as intestinal infection, sharp stomach. Inadequate antibiotic treatment provokes development of intestinal dysbacteriosis. Operation for the hyper diagnosed sharp abdominal pathology involves the long recovery period, can have a number of surgical complications.
Diagnostic difficulties are connected with not specificity of symptomatology, its similarity with manifestations of a number of gastrointestinal diseases, bad awareness of pediatricians on existence of abdominal option of migraine. At primary address during diagnostics it is necessary to confirm exclusively functional character of a pain syndrome that demands careful inspection on existence of anatomic, neoplastic, inflammatory violations of bodies of a GIT. The list of the recommended researches includes:
- General survey. It is carried out by the pediatrician, the gastroenterologist. Lack of signs of damage of a GIT is characteristic. Language is pure, the palpation an epigastriya is painless, symptoms of irritation of a peritoneum are absent, intestines not . In the period of a paroxysm the palpation of a stomach is complicated because of a giperesteziya.
- Laboratory diagnostics. The general blood test, urine, a koprogramm meet standard, do not display inflammatory changes. Biochemical blood test without pathological shifts. Normal level of pancreatic enzymes (amylase, a lipase) allows to exclude pancreas pathology. Bacteriological crops the calla does not give growth of pathogenic microflora.
- Ultrasonography of abdominal organs and kidneys. Sonografiya is necessary for assessment of an anatomic structure of bodies, detection of organic pathology. Is of great importance when carrying out a difdiagnostika. If necessary ultrasonography of kidneys can be added with excretory urography.
- Intestines X-ray analysis. It is carried out with contrasting. Does not confirm anomalies of development, changes of a configuration and relief mucous. The Krone helps to exclude new growths, an invagination, intestinal impassability, a disease.
- Doppler sonography of a belly aorta. Increase in speed of a linear blood-groove in belly department of an aorta is typical for most of patients. Changes are especially expressed when carrying out inspection during a paroxysm.
- Brain MRT. The tomography is shown in the presence of a tsefalgiya. The research is necessary for an exception of intrakranialny pathology: tumors of a brain, hydrocephaly, cerebral cyst, intra cranial hematoma.
The diagnosis is exposed at compliance of symptomatology to the Roman criteria of diagnostics and absence of other causal pathology. Existence in the anamnesis not less than five same episodes of the stupid okolopupochny or diffusion abdominalgiya lasting 1-72 hours which is followed by at least two listed symptoms is fundamental: nausea, vomiting, pallor, anorexia. Differential diagnostics is carried out with intestinal infections (dysentery, a food toksikoinfektion, salmonellosis), enteropatiya, a sharp stomach, a syndrome of the angry intestines, functional dyspepsia, pancreatitis, diseases of kidneys.
Treatment of abdominal migraine
The principles of therapy correspond to a technique of treatment of simple migraine. Therapeutic events have to be held in a complex, include knocking over of paroxysms of an abdominalgiya and mezhpristupny treatment. Patients are supervised by the neurologist, the neurologist-algolog. The main medical stages are:
- Therapy of a paroxysm. Usual analgetics are ineffective. Are used nonsteroid anti-inflammatory (ibuprofen), the combined kodeinsoderzhashchy pharmaceuticals, paracetamol. Means from group of triptan are productive (a sumatriptana, an eletriptana) however their application in pediatric practice is limited. Repeated vomiting acts as the indication to purpose of antiemetic medicines. Certain authors point to a possibility of knocking over of an attack at children by intravenous administration of valproyevy acid.
- Preventive treatment. Identification of trigger factors, an explanatory conversation with the child and his parents about mechanisms of emergence of attacks, elimination of provocative influences is necessary. The general recommendations are observance of the mode of a dream and rest, restriction of psychological and physical activities, normalization of food, an exception of provocative products. AM with high frequency of attacks demands carrying out preventive pharmacotherapy. Use of the following medicines is possible: tsiprogeptadina, pizotifena, propranolol, sedatives.
Forecast and prevention
Exact predictive data are absent. Mainly good-quality current is characteristic. Separate researches demonstrate disappearance of abdominalgiya after a growing. At 70% of patients of children's age irrespective of existence of migrenozny episodes of a headache abdominal migraine is transformed to a classical tsefalgichesky form over time. The prevention of AM is promoted by the benevolent confidential psychological atmosphere in a family, observance of a day regimen and food, the adequate psychoemotional load of the child corresponding to features of his nervous system.