What is Abdominal Migraine?
Abdominal migraine is a syndrome characterized by recurrent stereotypic episodes of paroxysmal abdominal pain and nausea and/or vomiting with complete wellness between episodes, typically occurring in children and adolescents, often associated with a positive family history of migraine. 1, 2, 3
Core Clinical Features
Abdominal migraine consists of episodic attacks of severe abdominal pain with vasomotor symptoms (pallor), nausea, and vomiting that occur in discrete episodes with complete return to baseline health between attacks. 4, 5 The pain is paroxysmal and recurrent, distinguishing it from continuous or progressive abdominal pathology. 2, 3
Associated Symptoms
- Pallor, anorexia, headache, and photophobia commonly accompany the abdominal pain episodes. 4
- The stereotypic pattern—meaning each episode follows the same clinical presentation in a given patient—is a key diagnostic feature. 1, 2
- Complete wellness between episodes is mandatory for diagnosis, differentiating it from organic gastrointestinal disease. 2, 3
Epidemiology and Natural History
Abdominal migraine affects 0.2% to 4.1% of children, making it relatively common in the pediatric population. 4, 5 The condition typically has its onset during childhood or adolescence. 3, 6
Progression Pattern
- Most children with abdominal migraine do not continue having these episodes into adulthood; instead, they often develop typical migraine headaches as they age. 3, 5
- Some patients develop probable migraine and recurrent abdominal pain patterns in adulthood rather than classic abdominal migraine. 5
- Rarely, abdominal migraine can begin for the first time in adults (documented as late as age 22), and in exceptional cases, migraine headache and recurrent abdominal pain coexist in adult patients. 6
Relationship to Migraine
Abdominal migraine and cyclical vomiting syndrome are sometimes called "migraine equivalents" because they share overlapping characteristics with migraine but lack the cardinal symptom of headache. 3
- A strong family history of migraine significantly strengthens the diagnosis of abdominal migraine. 1, 2
- The pathophysiology is assumed to overlap with migraine headache, involving a combination of visceral hypersensitivity, gut-brain enteric nervous system alterations, and psychological factors. 3, 4
Diagnostic Approach
Abdominal migraine is a clinical diagnosis based on pattern recognition, with diagnostic criteria outlined in both the Rome IV criteria and the International Classification of Headache Disorders III (ICHD-3) criteria. 4, 5
Key Diagnostic Elements
- Look for recurrent stereotypic episodes with complete wellness between attacks—this pattern is pathognomonic. 1, 2
- Document the presence of associated symptoms: pallor, nausea, vomiting, anorexia, headache, or photophobia during episodes. 4
- Obtain detailed family history, as positive family history of migraine significantly supports the diagnosis. 1, 2
- Maintain a headache/abdominal pain diary to identify triggers, document episode frequency and duration, and monitor treatment effectiveness. 1
Clinical Significance
Abdominal migraine is likely underdiagnosed and poorly understood, yet individuals with this condition report lower quality of life, making accurate diagnosis important. 4, 5 The limited recognition of this condition by the medical community has historically hindered research and optimal treatment development. 5
Medication Overuse Consideration
Analgesic overuse can cause worsening of abdominal pain in patients with abdominal migraine, similar to medication-overuse headache in typical migraine. 6 This creates a vicious cycle where increased pain leads to more medication use, which paradoxically worsens the pain frequency and severity. 6