Abdominal Migraines

Dr Ryen, I'm not sure where to turn. My daughter Candace has been into the ER every month or so over the last year for stomach pain. She's been poked a million times for bloodwork, had ultrasounds and CT scans, but everything comes back "normal" and we still don't have any answers. All the while, Candace hates hospitals and continues to have the same problem. She's only 9 years old. What should I do?!

 - Tara, Albuquerque, NM

Tara, I only have one question for you: who in the family gets migraines? This condition is genetically-linked, passed on from parents to kids, so if you or her dad has ever gotten migraines, her abdominal symptoms may be coming from her head. 

Nobody knows for sure what causes migraines, but they're thought to be related to abnormal activity of blood vessels in the brain. Triggers can include lack of sleep, menstrual cycles, stress, or hunger, but many migraines occur without any provocation at all, lasting anywhere from a few hours to a few days.

In adults, the most common symptoms are headaches (one-sided, throbbing), oversensitivity to light and sound, and nausea. However, virtually any neurologic symptom is fair game - vertigo/dizziness, partial paralysis, even vision loss. It all depends on which part of the brain is affected. About a third of people get “aura” - flashes of light or color before the headache starts. Once they get going, most migraines make you want to curl up in a dark room and go to sleep.

Unlike the headaches that adults get, migraines can affect kids in their gut. Before adolescence, they often present abdominal pain and nausea. Investigations at the hospital are typically normal, since the problem isn't in the abdomen, it's the brain. As kids grow through adolescence, their abdominal symptoms stop and headaches start.

All patients who come to the hospital with abdominal pain and nausea are taken pretty seriously. Appendicitis, gall bladder infections, ovarian cysts, bowel obstruction… all sorts of nasty (and potentially deadly) conditions present like this. So I’m not surprised Candace has been poked so many times - without bloodwork, you never know if she has a burst appendix or just another migraine. However, the one symptom migraines never cause is fever. So if her temperature is normal, you probably have some time to try some medications at home.

When it comes to treating migraines, my adult patients get prescriptions for ketorolac (a strong anti-inflammatory similar to ibuprofen) and metoclopramide (an anti-nauseant). If that doesn’t work, triptans are a class of medication specifically designed to stop migraines. For children, whatever treatment works for parents usually helps their kids too. Ibuprofen (Advil) and acetaminophen (Tylenol) are a great place to start. Talk to your doctor if those don't work.

The most important thing to remember is to TREAT MIGRAINES EARLY! Think of it like a fire starting in your house: don't wait to see if it'll settle on its own - hit it hard as soon as possible. Even minutes make a difference. If “aura” happens beforehand, that’s the best time to treat it, before the pain even starts. If a migraine becomes full-blown, medications by mouth often won't work and IV treatment in a hospital is the only thing that'll kick it. If migraines are severe and frequent, talk to your doctor about how to prevent them.

The next time Candace gets another bout of abdominal pain, get some medication in her pronto and send her to bed. With any luck, she’ll wake up feeling much better and you’ll save yourself another trip to the hospital. Put some meds in her backpack to take to school, with a note to her teacher that she should take a dose at the earliest sign the pain is starting.

So, if you or Candace's father gets migraines, this may be the cause of her mysterious episodes of abdominal pain. In a few years, her abdominal symptoms will be replaced by headaches. This is likely something she’ll struggle with her whole life, but most patients are able to manage their migraines fairly well with by knowing how they work, avoiding triggers, and finding medications that work for them.

And remember, if she spikes a fever, head back to the hospital. 

© D. B. Ryen Incorporated, March 2025.  

Disclaimer: This is not medical advice. DBRyen.com does not assume any liability due to incorrect or complete information you might obtain here. The information on this website (and elsewhere on the internet) does not replace the personalized advice from a qualified healthcare practitioner you trust.