Abdominal Migren
Özet
Abdominal migrenin tanısı klinik açıdan zorlayıcı olabilmekle birlikte, baş ağrısının eşlik etmediği bir migren fenotipi olarak ele alınabilir. Klinik tablo, ataklar arasında tamamen asemptomatik dönemlerin izlendiği, epizodik orta karın ağrısı ile karakterizedir. Ağrıya sıklıkla bulantı ve kusma eşlik edebilir; bu durum abdominal migreni tekrarlayan karın ağrısı ve siklik kusma sendromu spektrumu içinde konumlandırır. Ağrı genellikle künt nitelikte olup orta ile şiddetli düzeyde tanımlanır, 1–72 saat sürebilir ve çoğunlukla orta hatta yerleşmekle birlikte periumbilikal olabilir ya da hasta tarafından net olarak lokalize edilemeyebilir. Tanı kriterlerinin karşılanabilmesi için, karın ağrısı sırasında iştahsızlık, bulantı, kusma veya solukluk bulgularından en az ikisinin eşlik etmesi gereklidir. Tanı koymadan önce altta yatan organik bir gastrointestinal hastalığın dışlanması amacıyla ayrıntılı öykü, dikkatli fizik muayene ve uygun laboratuvar incelemeleri yapılmalıdır. Çocukların önemli bir kısmı nörolojik ya da gelişimsel bir sekel olmaksızın erişkinliğe ulaşsa da bazı olgularda semptomlar tekrarlamakta ve yaşam kalitesini belirgin şekilde bozabilmektedir. Erişkin hastalar, semptomların özgül olmaması nedeniyle sıklıkla çok sayıda tetkik ve tedaviye maruz kalmaktadır. Erişkin abdominal migrende farkındalığın artırılması, zamanında tanı ve uygun yönetim açısından kritik önem taşır ve uzun dönem olumsuz sonuçların önlenmesine katkı sağlayacaktır.
Diagnosing abdominal migraine can be clinically challenging; however, it may be considered a migraine phenotype that does not necessarily require concomitant headache. The clinical picture is characterized by episodic mid-abdominal pain with completely asymptomatic periods between attacks. The pain may frequently be characterized by additional symptoms, including nausea and vomiting, which classifies abdominal migraine within the spectrum of recurrent abdominal pain and cyclic vomiting syndrome. The pain is typically characterized as dull and aching, with a severity described as moderate to severe. Its duration can last from 1 to 72 hours, and its location is usually in the midline, although the patient may not be able to clearly localize it. To be classified as a diagnosis, the presence of abdominal pain must be accompanied by at least two of the following symptoms: anorexia, nausea, vomiting, or pallor. A comprehensive history, systematic physical examination, and targeted laboratory investigations are essential to exclude underlying organic gastrointestinal diseases prior to diagnosis. While a large percentage of children progress to adulthood without enduring neurologic or developmental sequelae, symptoms may persist in some cases, potentially resulting in severe impact on quality of life. Adult patients are often subjected to a range of investigations and treatments due to the non-specificity of the symptoms. Increasing awareness in adult abdominal migraine is critical for timely diagnosis and appropriate management and will contribute to the prevention of long-term adverse outcomes.
Referanslar
Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLOS One. 2015;10(5):e0126982. doi:10.1371/journal.pone.0126982
Hyams JS, Burke G, Davis PM, et al. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. The Journal of Pediatrics. 1996;129(2):220–226. doi: 10.1016/S0022-3476(96)70246-9
Hyams JS, Di Lorenzo C, Saps M, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2016;150(6):1456–1468.e2. doi:10.1053/j.gastro.2016.02.015
Carson L, Lewis D, Tsou M, et al. Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Headache: The Journal of Head and Face Pain. 2011;51(5):707–712. doi: 10.1111/j.1526-4610.2011.01855.x
Azmy DJ, Qualia CM. Review of abdominal migraine in children. Gastroenterology & Hepatology. 2020;16(12):632–639.
Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The effects of the Rome IV criteria on pediatric gastrointestinal practice. Current Gastroenterology Reports. 2020;22(5):21. doi: 10.1007/s11894-020-00760-8
Blitzsten NL, Brams WA. Migraine with abdominal equivalent. Journal of the American Medical Association. 1926;86(10):675–677.
doi: 10.1001/jama.1926.02670360015006
Symon DN, Russell G. Abdominal migraine: a childhood syndrome defined. Cephalalgia. 1986;6(4):223–228. doi: 10.1046/j.1468-2982.1986.060422
Mani J, Madani S. Pediatric abdominal migraine: current perspectives on a lesser known entity. Pediatric Health, Medicine and Therapeutics. 2018;9:47–58. doi: 10.2147/PHMT.S127210
Irwin S, Barmherzig R, Gelfand A. Recurrent gastrointestinal disturbance: abdominal migraine and cyclic vomiting syndrome. Current Neurology and Neuroscience Reports. 2017;17(3):21. doi: 10.1007/s11910-017-0731-4
Niriella MA, Jayasena H, Nishad N, et al. Abdominal migraine in adults: a narrative review. Cureus. 2025;17(6):e85958. doi:10.7759/cureus.85958
Paydaş AB, Yücel A, Güven AS. A prospective observational study on the underdiagnosis of pediatric abdominal migraine.The Turkish Journal of Pediatrics 2025; 67:875-884. doi: 10.24953/turkjpediatr.2025.6575
Suliman O, Mahjoub E, Abutwaimah J, et al. Prevalence and clinical features of abdominal migraine in children: a systematic review. Journal of Advances in Medicine and Medical Research. 2025;37(6):64–76. doi: 10.9734/jammr/2025/v37i65852
Tency NK, Roy A, Krishnakumaran N, Thomas AM. Unraveling abdominal migraine in adults: a comprehensive narrative review. Cureus. 2023;15(8):e43760. doi:10.7759/cureus.43760
Napthali K, Koloski N, Talley NJ. Abdominal migraine. Cephalalgia. 2016;36(10):980–986. doi:10.1177/0333102415617748
Aggarwal, M., Puri, V., & Puri, S. (2012). Serotonin and CGRP in migraine. Annals of neurosciences, 19(2), 88–94. https://doi.org/10.5214/ans.0972.7531.12190210
Lenglar T, Caula C, Moulding T, et al. Brain to belly: abdominal variants of migraine and functional abdominal pain disorders associated with migraine. Journal of Neurogastroenterology and Motility. 2021;27(4):482–494. doi: 10.5056/jnm20290
Gamil NM, Ghorab RM, Elsadawy RZ, et al. A review on gut microbiota and migraine severity: a complex relationship. Inflammopharmacology. 2025;33(1):1–24. doi: 10.1007/s10787-025-02023-2
Arnold, M. (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1 - 211. doi: 10.1177/0333102417738202.
Dees B, Coleman-Jackson R, Hershey LA. Managing migraine and other headache syndromes in those over 50. Maturitas. 2013;76(3):243–246. doi:10.1016/j.maturitas.2013.04.009
Symon D, Russell G. Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Archives of Disease in Childhood. 1995;72(1):48–50. doi:10.1136/adc.72.1.48
Hindiyeh NA, Zhang N, Farrar M, et al. The role of diet and nutrition in migraine triggers and treatment: a systematic literature review. Headache: The Journal of Head and Face Pain. 2020;60(7):1300–1316. doi:10.1111/head.13813
Poboży T, Janowski K, Michalak K, et al. Food in migraine management: dietary interventions in the pathophysiology and prevention of headaches—A narrative review. Nutrients. 2025;17(21):3471. doi:10.3390/nu17213471
Yamanaka G, Morichi S, Suzuki S, et al. A review on the triggers of pediatric migraine with the aim of improving headache education. Journal of Clinical Medicine. 2020;9(11):3717. doi:10.3390/jcm9113717
Elmazny, A., Magdy, R., Hussein, M. et al. Migraine triggers and lifestyle modifications: an assessment of patients’ awareness and the role of healthcare providers in patient education. Journal of Headache Pain 26, 189 (2025). doi: 10.1186/s10194-025-02107-y
Reddy SK, Matta S. The digestive system. Kliegman RM (Ed.), In: Nelson Pediatric Symptom-Based Diagnosis 2nd ed. Philadelphia: Elsevier; 2022. p.2390–2398.
Referanslar
Korterink JJ, Diederen K, Benninga MA, Tabbers MM. Epidemiology of pediatric functional abdominal pain disorders: a meta-analysis. PLOS One. 2015;10(5):e0126982. doi:10.1371/journal.pone.0126982
Hyams JS, Burke G, Davis PM, et al. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. The Journal of Pediatrics. 1996;129(2):220–226. doi: 10.1016/S0022-3476(96)70246-9
Hyams JS, Di Lorenzo C, Saps M, et al. Childhood functional gastrointestinal disorders: child/adolescent. Gastroenterology. 2016;150(6):1456–1468.e2. doi:10.1053/j.gastro.2016.02.015
Carson L, Lewis D, Tsou M, et al. Abdominal migraine: an under-diagnosed cause of recurrent abdominal pain in children. Headache: The Journal of Head and Face Pain. 2011;51(5):707–712. doi: 10.1111/j.1526-4610.2011.01855.x
Azmy DJ, Qualia CM. Review of abdominal migraine in children. Gastroenterology & Hepatology. 2020;16(12):632–639.
Baaleman DF, Di Lorenzo C, Benninga MA, Saps M. The effects of the Rome IV criteria on pediatric gastrointestinal practice. Current Gastroenterology Reports. 2020;22(5):21. doi: 10.1007/s11894-020-00760-8
Blitzsten NL, Brams WA. Migraine with abdominal equivalent. Journal of the American Medical Association. 1926;86(10):675–677.
doi: 10.1001/jama.1926.02670360015006
Symon DN, Russell G. Abdominal migraine: a childhood syndrome defined. Cephalalgia. 1986;6(4):223–228. doi: 10.1046/j.1468-2982.1986.060422
Mani J, Madani S. Pediatric abdominal migraine: current perspectives on a lesser known entity. Pediatric Health, Medicine and Therapeutics. 2018;9:47–58. doi: 10.2147/PHMT.S127210
Irwin S, Barmherzig R, Gelfand A. Recurrent gastrointestinal disturbance: abdominal migraine and cyclic vomiting syndrome. Current Neurology and Neuroscience Reports. 2017;17(3):21. doi: 10.1007/s11910-017-0731-4
Niriella MA, Jayasena H, Nishad N, et al. Abdominal migraine in adults: a narrative review. Cureus. 2025;17(6):e85958. doi:10.7759/cureus.85958
Paydaş AB, Yücel A, Güven AS. A prospective observational study on the underdiagnosis of pediatric abdominal migraine.The Turkish Journal of Pediatrics 2025; 67:875-884. doi: 10.24953/turkjpediatr.2025.6575
Suliman O, Mahjoub E, Abutwaimah J, et al. Prevalence and clinical features of abdominal migraine in children: a systematic review. Journal of Advances in Medicine and Medical Research. 2025;37(6):64–76. doi: 10.9734/jammr/2025/v37i65852
Tency NK, Roy A, Krishnakumaran N, Thomas AM. Unraveling abdominal migraine in adults: a comprehensive narrative review. Cureus. 2023;15(8):e43760. doi:10.7759/cureus.43760
Napthali K, Koloski N, Talley NJ. Abdominal migraine. Cephalalgia. 2016;36(10):980–986. doi:10.1177/0333102415617748
Aggarwal, M., Puri, V., & Puri, S. (2012). Serotonin and CGRP in migraine. Annals of neurosciences, 19(2), 88–94. https://doi.org/10.5214/ans.0972.7531.12190210
Lenglar T, Caula C, Moulding T, et al. Brain to belly: abdominal variants of migraine and functional abdominal pain disorders associated with migraine. Journal of Neurogastroenterology and Motility. 2021;27(4):482–494. doi: 10.5056/jnm20290
Gamil NM, Ghorab RM, Elsadawy RZ, et al. A review on gut microbiota and migraine severity: a complex relationship. Inflammopharmacology. 2025;33(1):1–24. doi: 10.1007/s10787-025-02023-2
Arnold, M. (2018). Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia, 38, 1 - 211. doi: 10.1177/0333102417738202.
Dees B, Coleman-Jackson R, Hershey LA. Managing migraine and other headache syndromes in those over 50. Maturitas. 2013;76(3):243–246. doi:10.1016/j.maturitas.2013.04.009
Symon D, Russell G. Double blind placebo controlled trial of pizotifen syrup in the treatment of abdominal migraine. Archives of Disease in Childhood. 1995;72(1):48–50. doi:10.1136/adc.72.1.48
Hindiyeh NA, Zhang N, Farrar M, et al. The role of diet and nutrition in migraine triggers and treatment: a systematic literature review. Headache: The Journal of Head and Face Pain. 2020;60(7):1300–1316. doi:10.1111/head.13813
Poboży T, Janowski K, Michalak K, et al. Food in migraine management: dietary interventions in the pathophysiology and prevention of headaches—A narrative review. Nutrients. 2025;17(21):3471. doi:10.3390/nu17213471
Yamanaka G, Morichi S, Suzuki S, et al. A review on the triggers of pediatric migraine with the aim of improving headache education. Journal of Clinical Medicine. 2020;9(11):3717. doi:10.3390/jcm9113717
Elmazny, A., Magdy, R., Hussein, M. et al. Migraine triggers and lifestyle modifications: an assessment of patients’ awareness and the role of healthcare providers in patient education. Journal of Headache Pain 26, 189 (2025). doi: 10.1186/s10194-025-02107-y
Reddy SK, Matta S. The digestive system. Kliegman RM (Ed.), In: Nelson Pediatric Symptom-Based Diagnosis 2nd ed. Philadelphia: Elsevier; 2022. p.2390–2398.
