What is Abdominal Migraine?
Abdominal migraine is a recurrent functional pain disorder characterized by stereotypic episodes of paroxysmal, severe midline abdominal pain lasting hours to days, accompanied by vasomotor symptoms (pallor, nausea, vomiting, anorexia) and often photophobia, with complete wellness between attacks. 1, 2, 3
Core Clinical Features
Abdominal migraine is considered a "migraine equivalent"—a variant of migraine that lacks the cardinal symptom of headache but shares the same underlying pathophysiology. 2
Defining Characteristics
- Recurrent attacks of acute, severe abdominal pain that is typically midline, paroxysmal, and lasts from hours to a few days (not continuous chronic pain) 2, 3
- Complete symptom freedom between episodes—patients return to baseline health when not experiencing an attack 2, 3
- Associated vasomotor symptoms including pallor (skin blanching), nausea, vomiting, anorexia, and sometimes headache or photophobia during attacks 1, 3
- Strong family history of migraine significantly strengthens the diagnosis and is present in most cases 1
- Stereotypic pattern—each patient's attacks follow a consistent, recognizable pattern 1, 3
Epidemiology and Natural History
- Predominantly affects children and adolescents (prevalence 0.2% to 4.1% in pediatric populations), though it can present for the first time in adults 2, 3
- Many children with abdominal migraine eventually develop typical migraine headaches as they mature, supporting the concept of migraine equivalents 2, 3
- Likely underdiagnosed due to poor recognition and understanding of the condition 3
Pathophysiology
The underlying mechanisms are assumed to overlap with migraine headache and include:
- Visceral hypersensitivity (heightened pain perception in abdominal organs) 3
- Gut-brain enteric nervous system alterations (disrupted communication between the gastrointestinal tract and central nervous system) 3
- Psychological factors contributing to symptom expression 3
Diagnostic Approach
Abdominal migraine is a clinical diagnosis based on pattern recognition rather than laboratory or imaging findings. 1, 3
Key Diagnostic Considerations
- Consider abdominal migraine in the differential diagnosis of recurrent abdominal pain, particularly when there is a stereotypic pattern and complete wellness between episodes 1
- Maintain a headache/abdominal pain diary to identify triggers, document attack frequency and duration, and monitor treatment effectiveness 1
- Physical examination must exclude other causes—this is mandatory to rule out secondary organic pathology 1
Red Flags Requiring Alternative Workup
While not explicitly detailed in the migraine-specific guidelines, standard practice dictates excluding:
- Progressive or worsening symptoms
- Unexplained weight loss or growth failure
- Gastrointestinal bleeding
- Persistent symptoms between episodes
- Abnormal physical examination findings
Impact on Quality of Life
Individuals with abdominal migraine report significantly lower quality of life, making accurate diagnosis and treatment essential despite the condition being poorly understood. 3