The answer

It sounds as though Poppy is suffering from abdominal migraine (AM), a form of migraine predominantly seen in children aged five to nine years, though occasionally adults do experience it. The symptoms are as Melissa describes: acute, severe pain in the centre of the abdomen, nausea, vomiting, loss of appetite and pallor, lasting anything from an hour to three days. Headache is absent. AM is more common in the children of parents who have a history of migraine, but is only diagnosed once other causes of the symptoms have been excluded.

Treatment is either symptomatic – hot water bottles and simple analgesia – or, if that doesn’t work to a decent degree, as for any other migraine, triptans can be taken, although it is worth noting that not all serotonin1-receptor agonists (or 5HT1-receptor agonists, as the drug class is more accurately known) are licensed for use in children.

If the child is suffering from frequent AM, preventative therapy (e.g. pizotifen or propranolol) may be tried, although again, the age of the patient affects the choice. Trigger avoidance is also recommended – for example, cutting back on items such as chocolate and caffeine, ensuring hydration levels are maintained, keeping stress under control, and making sure the child has a regular routine for sleeping and eating. Keeping a diary can be very helpful in this respect.